Voices of the Women's Health Movement, Volume One by Veronica Liu

voices of THE WOMEN’S HEALTH MOVEMENT VOLUME ONE

BARBARA SEAMAN with LAURA ELDRIDGE

SEVEN STORIES PRESS New York

ÂŠ 2012 by Barbara Seaman and Laura Eldridge Portions of this book appeared in For Women Only! ÂŠ 1999 by Gary Null and Barbara Seaman (Seven Stories Press). All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, including mechanical, electric, photocopying, recording, or otherwise, without the prior written permission of the publisher. Seven Stories Press 140 Watts Street New York, NY 10013 www.sevenstories.com

College professors may order examination copies of Seven Stories Press titles for a free six-month trial period. To order, visit http://www.sevenstories.com/textbook or send a fax on school letterhead to (212) 226-1411. Book design by Jon Gilbert Library of Congress Cataloging-in-Publication Data Voices of the women's health movement / edited by Barbara Seaman ; with Laura Eldridge. p. cm. Includes bibliographical references and index. ISBN 978-1-60980-444-2 (v. 1) -- ISBN 978-1-60980-446-6 (v. 2) 1. Women--Health and hygiene. 2. Women--Health and hygiene--History. I. Seaman, Barbara. II. Eldridge, Laura. [DNLM: 1. Women's Health--United States--Collected Works. 2. Feminism--United States--Collected Works. 3. Feminism--history--United States--Collected Works. 4. History, 19th Century--United States--Collected Works. 5. History, 20th Century--United States--Collected Works. 6. Women's Health--history--United States--Collected Works. 7. Women's Rights--United States--Collected Works. 8. Women's Rights--history--United States--Collected Works. WA 309] RA564.85.V65 2012 362.1082--dc22 2010016341 Printed in the United States of America 9 8 7 6 5 4 3 2 1

Contents Acknowledgments .................................................................................................... Introduction by Barbara Seaman with Laura Eldridge .........................................................

CHAPTER 1: IN THE BEGINNING Witches, Midwives and Nurses: A History of Women Healers by Barbara Ehrenreich and Deirdre English ................................................... Out of Conflict Comes Strength and Healing: Women’s Health Movements by Dr. Helen I. Marieskind ................................................................................ Medicine and Morality in the Nineteenth Century by Kristin Luker.................................................................................................. Ain’t I a Woman? by Sojourner Truth............................................................................................. On Motherhood by Elizabeth Cady Stanton ................................................................................ Why Elizabeth Isn’t on Your Silver Dollar by Barbara Seaman............................................................................................ Sylvia Bernstein Seaman by Karen Bekker ................................................................................................. Women’s Health and Government Regulation: 1820-1949 by Suzanne White Junod ...................................................................................

Fanny Burney’s Letter to Her Sister by Fanny Burney ................................................................................................ A My Name is Alice by Jennifer Baumgardner..................................................................................

CHAPTER 2: TAKING OUR BODIES BACK: THE WOMEN’S HEALTH MOVEMENT The Role of Advocacy Groups in Research on Women’s Healthy by Barbara Seaman and Susan Wood............................................................... Inside and Out: Two Stores of the Rumblings Beneath the Quiet by Suzanne Clores ............................................................................................. Women’s Health and Government Regulation: 1950-1980 by Suzanne White Junod ................................................................................... Sisterhood by Gloria Steinem .............................................................................................. Dear Injurious Physician by Barbara Seaman............................................................................................ The Ultimate Revolution by Shulamith Firestone ..................................................................................... Our Bodies, Ourselves: Remembering the Dignity edited by Mei Hwei Astella and Sarah J. Shey ................................................. Looking back on Our Bodies, Ourselves edited by Joanna Perlman and Sarah J. Shey................................................... Alice Wolfson interview by Tania Katenjian ............................................................................ Belita Cowan interview by Tania Katenjian ............................................................................ A Mother’s Story by Helen Rodriguez-Trias.................................................................................. Helen Rodriguez-Trias interview by Tania Katenjian ............................................................................ A is for Activism by Byllye Avery ...................................................................................................

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Byllye Avery interview by Tania Katenjian ............................................................................ The Female Eunuch by Germaine Greer ............................................................................................ Excerpt from The Hite Report on Shere Hite by Shere Hite ...................................................................................................... In Defense of Shere Hite by Sarah J. Shay.................................................................................................. Susan Brownmiller: Memoir of a Revolutionary by Carrie Carmichael......................................................................................... A Mother’s Story by Patsy Mink ..................................................................................................... DES by Sybil Shainwald.............................................................................................

CHAPTER 3: BIRTH CONTROL Excerpt from Devices and Desires by Andrea Tone .................................................................................................. Racism, Birth Control, and Reproductive Rights by Angela Davis.................................................................................................. Informed Consent by Elizabeth Siegel Watkins............................................................................... Julie is not a Statistic by Barbara Seaman............................................................................................ Phillip Corfman interview by Tania Ketenjian ............................................................................ A Pill for Men by Barbara Seaman............................................................................................ Norplant: The Contraception You’re Stuck With by Barbara Seaman............................................................................................ Fertility Awareness in America by Katie Singer ...................................................................................................

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CHAPTER 4: MENSTRUATION If Men Could Menstruate by Gloria Steinem .............................................................................................. The Selling of Pre-Menstrual Syndrome Andrea Eagan ..................................................................................................... Seasonale, Lybrell and Menstrual Suppression Pills by Sara Germain ................................................................................................

CHAPTER 5: PREGNANCY AND BIRTHING Childbirth in America edited by Victoria Eng and Sonia Lander ........................................................ The Cultural Warping of Childbirth by Doris Haire .................................................................................................... Motherhood by Letty Cottin Pogrebin ................................................................................... In which a Sensible Woman Persuades Her Doctor, Her Family, and Her Friends to Help Her Give Birth at Home by Barbara Katz Rothman ................................................................................. How Late Can You Wait to Have a Baby? by Barbara Seaman............................................................................................ How Science is Redefining Parenthood by Barbara Katz Rothman ................................................................................. Having Anne by Laura Yeager .................................................................................................. Preface to With Child by Ariel Chesler .................................................................................................. Misconceptions by Gena Corea.................................................................................................... Determination by Barbara Katz Rothman ................................................................................. Patenting Life: Are Genes Objects of Commerce? by Barbara Katz Rothman and Ruth Hubbard ................................................

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Geriatric Obstetrics: Oh Baby! by Carrie Carmichael......................................................................................... Bold Type: Childbirth is Powerful by Barbara Findlen ............................................................................................ Arlene Eisenberg interview by Tania Katenjian ............................................................................ Lives: When One is Enough by Amy Richards ................................................................................................ Excerpt from Love Mom by Cynthia Baseman.......................................................................................... Is This Any Way to Have a Baby? by Barbara Seaman............................................................................................

CHAPTER 6: MOTHERHOOD Yes, We Have No Bambinos by Molly Haskell................................................................................................. Dr. Spock’s Advice to New Mothers by Alix Kates Shulman....................................................................................... Lovely Me by Barbara Seaman............................................................................................ My Mother’s Death: Thoughts on Being a Separate Person by Judith Rossner............................................................................................... Take the Blame off Mother by Paula J. Kaplan .............................................................................................. The Madonna’s Tears for a Crack in My Heart by Audrey Flack.................................................................................................. Breastfeeding Revisited by Margot Slade ................................................................................................. Moms in Dark about OTC Drugs, Survey Shows by Frances Cerra Whittelsey ............................................................................. The Baby Contract by Susan Jordan .................................................................................................

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Monster Mommies by Erica Jong ...................................................................................................... They Came to Stay by Marjorie Margolies and Ruth Gruber.......................................................... An Adopted Daughter Meets Her Natural Mother by Betty Jean Lifton ........................................................................................... What Do You Love About Being a Lesbian Mom? by Catherine Gund ............................................................................................ On Becoming a Grandmother by Francine Klagsbrun ......................................................................................

CHAPTER 7: MENOPAUSE AND AGING Flashback: A History of Menopause by Laura Eldridge............................................................................................... Excerpt from The Changing Years by Madeline Gray............................................................................................... Promise Her Anything, but Give Her Cancer by Barbara Seaman............................................................................................ Excerpt from Greatest Experiment Ever Performed on Women by Barbara Seaman............................................................................................ The Bitter Pill by Leora Tannenbaum ...................................................................................... A Friend Indeed: The Grandmother of Menopause Newsletters by Sari Tudiver ................................................................................................... Excerpt from The Truth About Hormone Replacement Therapy by the National Women’s Health Network ....................................................... On Aging by Joan Ditzion ..................................................................................................

CHAPTER 8: GYNECOLOGICAL SURGERY Needless Hysterectomies by Marcia Cohen................................................................................................

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So, You’re Going to Have a New Body! by Lynne Sharon Schwartz................................................................................ Keeping All Your Eggs in One Basket by Barbara Seaman............................................................................................

CHAPTER 9: ABORTION I am Roe by Norma McCorvey.......................................................................................... The Jane Collective by Pauline Bart, with additional commentary by Carol Downer................... The Abortion by Alix Kates Shulman....................................................................................... Starting the New York Abortion Access Fund: Grassroots Activism on Abortion Rights, from Vision to Reality by Irene Xanthoudakis and Lauren Porsch .....................................................

CHAPTER 10: LESBIAN, BISEXUAL AND TRANSGENDER HEALTH Excerpt from Sappho Was a Right On Woman by Sidney Abbott and Barbara Love ................................................................ Putting Lesbian Health in Focus by Vivian Labaton .............................................................................................. Lesbian Health Gains Long Due Attention from Institute of Medicine by Amy Allina ..................................................................................................... Look Both Ways by Jennifer Baumgardner.................................................................................. Women’s Health/Transgender Health: Intersections by Lauren Porsch ...............................................................................................

CHAPTER 11: GENDER AND MEDICINE Why Would a Girl Go into Medicine? by Margaret A. Campbell ..................................................................................

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A Woman in Residence by Michelle Harrison ......................................................................................... Venus and the Doctor by Betty Rothbart............................................................................................... Excerpt from Woman Doctor by Florence Haseltine and Yvonne Yaw ........................................................... Excerpt from Essays on Women by Edith Stein .................................................................................................... Interview with Susan Wood by Meghan Buckley ...........................................................................................

In Conclusion, In Memoriam, In Hope.............................................................755 About the Contributors ......................................................................................759 About the Editors ................................................................................................773 Index ....................................................................................................................775 Contents of Volume Two ..........................................................................................

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To My Daughter Elana Felicia —Barbara To My Grandmothers, Grace, Ellen, and Ray —Laura

Acknowledgments

  , thanks to our agent, Valerie Borchardt, who is generous and patient with her time and good advice, and also to Anne and Georges Borchardt. Many thanks to our editor, Theresa Noll, whose talent and calm never cease to amaze us— this book bears evidence of her vision and hard work in every section. Our gratitude goes also to Amy Scholder, who helped us to imagine what the book might look like and saw our plans realized. Our deepest admiration and thanks to Dan Simon, who we have been fortunate to know and work with for many years. Barbara thanks her co-founders of the National Women’s Health Network: Alice Wolfson, Belita Cowan, Phylis Chesler, PhD, and Mary Howell, MD. Also to Cindy Pearson, Olivia Cousins, PhD, and Amy Allina who carried on our goals. We are grateful to Phil Corfman, MD, and Richard Crout, MD (who stood up for informed consent in women’s health care), Judy Norsigian (OBOS), Pat Cody and Sybil Shainwald (on behalf of DES families), Maryann Napoli (Center for Medical Consumers), Susan Wood, PhD (formerly of the FDA), and Nancy Krieger, PhD. We are grateful also to Andrea Tone, Leonore Tiefer, Shere Hite, Gloria Steinem, Congresswoman Carolyn Maloney, Minna Elias, Sheryl Burt Ruzek, Barbara Brenner, Barbara Ehrenreich, Alice Yaker, Suzanne Parisian, MD, Byllye Avery, Susan Love, MD, David Michaels, PhD, Devra Lee Davis, PhD, Carolyn Westhoff, MD, Elizabeth Siegel Watkins, PhD, Pat Cody, Gordon Guyatt, MD, Bruce Stadel, Diane Meier, MD, Ben Loehnen, Jennifer Baumgardner, Nikki Scheuer, Sheila and Donald Bandman, Judge Emily Jane Goodman, Daniel Simon, Thomas Hartman, E. Neil Schachter, Debra Chase, Tara Parker Pope, Senator Ron Wyden, Nora Coffey, Warren Bell, MD, Alan Cassels, Wendy Armstrong, Colleen Fuller, Anne Rochon-Ford, Leora Tanenbaum, Abby Lippman, PhD, Harriet Rosenberg, PhD, Amy Richards, Pam Martens, Ariel Olive, Ann Fuller, Barbara Mintzes, Aubrey Blumsohn, MD, Frances C. Whittelsey, K-K Seaman, Ronnie Eldridge, Mavra Stark, Joan Michel, and Linda K. Nathan. xv

To our top-notch assistants: Sara Germain was relentless in helping us contact authors and choose selections. Megan Buckley, Helen Lowery, Reed Eldridge, and Seven Stories’ Daniella Gitlin were all helpful at crucial moments. Thanks to Kim Chung, who against all odds kept our computers running, and Maria Tylutki, who made sure everything else around the office was organized and as efficient as possible. And as always we are grateful to Agata Rumprecht-Behrens, who knows where things are better than either of us and who helps with whatever project we are working on despite her own busy schedule.

ADDITIONAL ACKNOWLEDGMENTS FROM BARBARA: My deepest gratitude to Dr. Susan Love, Dr. Neil Schachter, Deborah Chase, and Dr. Diane Meier. I am grateful to Ruth Gruber, my stepmother; my sisters, Elaine Rosner Jeria and Jeri Drucker, and Jeri’s husband Ernest Drucker, PhD; my children, Noah, Shira, and Elana; my sons-in-law, Urs Bamert and Timothy Walsh; my cousins, Amelia Rosner and Richard Hyfler; and Jesse Drucker, Nell Casey, and Henry Jeria. All my love to my grandchildren, Sophia Bamert, Idalia Bamert, Liam Walsh, and Ezekiel Walsh.

ADDITIONAL ACKNOWLEDGMENTS FROM LAURA: I would like to thank Irene Xanthoudakis, Rebecca Kraut, Lauren Porsch, Molly Barry, Rachel Fisher, Rumela Mitra, Helen Lowery, April Timko, Nicole Richman, Stephanie Kirk, Chi-Hyun Kim, Susan Masry, Rob Tennant, Rabbi Sari Laufer, Leonore Tiefer, Danie Greenwell, Alisa Kraut, Brian Cooke, Chris Rugen, Kim Jordan, Jenny Tomczak, Caroline Cruz, Amy Troy, Melissa Barrett, Jennifer Smith-Garvin, Karla Wiehagen, Anne Taylor, Kate Jefferson, Chad and Sonya Cooper, Miriam Silberstein, and Katie Walker. Much, much love goes to my brothers, David, Reed, and Peter, my dearest friends, and to my grandfather Paul Eldridge, Sr. My gratitude to the Seaman family, who have supported me through the years, and given me the chance to love and grieve my dear friend properly. They are like a second family and I am blessed to have them in my life. Many thanks to Sheldon, Beth, Marnie, Zachary and Josh Weinberg, and to the entire Weinberg/Josell/Alperin family. My parents Paul and Susan Eldridge are my best examples of how to lead meaningful, ethical lives. They have given me big shoes to fill and helped me as best they could to be up to the task. My son, Levi Jacob, has blessed and challenged me in countless ways. Jeremy Weinberg has been an unending source of love, patience and support. His kindness, intelligence, and humor are the great pleasures of my life, and I am truly fortunate to have him as my partner in everything I undertake.

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Introduction

    decided to re-set her son’s collarbone in the midnineteenth century she wasn’t trying to be radical, she was trying to be a good mother. She wasn’t trying to empower female healing and reject the mostly male medical establishment. She was trying to respond to the unalleviated pain of a cherished love one. In addition to her tireless writing and activism, Stanton was a mother of five children. Never daunted, Stanton moved her writing desk into the nursery and worked in between spending time with her brood. When her eldest son Daniel was born with a dislocated collarbone, the Stantons tried to get him the best medical care. Repeated doctors’ visits resulted in bandaging and treatments that actually made the problem worse. When a nurse helping Daniel refused to respond to the fact that his hand was turning blue from the bandages, saying, “I shall never interfere with the doctor,” Stanton sprang into action. She replaced the doctor only to be disappointed a second time. She wasn’t about to be fooled a third time, and, to the nurse’s shock, took off her son’s bandages and with arnica (a homeopathic remedy) and gentle pressure redressed her son’s bones. She concluded, “I learned another lesson in self-reliance. I trusted neither men nor books absolutely after this . . . but continued to use my ‘mother’s instinct,’ if ‘reason’ is too dignified a term to apply to a woman’s thoughts.” Her decisiveness goes to the heart of women’s health activism. It is almost always born of personal experience, often a social injustice acted out on the body. It is inherently and un-selfconsciously radical. Throughout human history—and more recently the nineteenth and twentieth centuries, we have witnessed brilliant and courageous examples of women taking control of their bodies and health choices. These experiences have often led to a greater sense of autonomy and equality. In many ways, it is an original rebellion. In these days as we debate the basic right of human beings to have medical care, it is an oftenmade point that one of the simplest ways to control a citizenry is through access to health

services. Women have known this for a long time, and the process of coming to understand and reject this system of control often helps them to see themselves as independent agents in a larger sense. In the nineteenth century, medical services were consolidated by doctors taken with new and changing medical technologies. As physicians and scientists pioneered surgeries, pharmaceuticals, and new mental health practices, they pushed out traditional (often female) providers, including midwives and makers of alternative medicines. Because these doctors were almost entirely male, they treated distinctively female body parts and health issues as disease. Male bodies were healthy and female ones were pathological. Nineteenth- and early twentieth-century ideas of the hysterical woman appall our twenty-first century sensibilities, but they haven’t entirely gone away. The way that menopause has been treated as a disease state is evidence that while there is now a different language used to misinterpret and medicate women’s bodies, the tendency persists. When Elizabeth Cady Stanton and the other first-wave feminists abandoned the recommendations of physicians, they were creating a model of resistance that lived on in small pockets of activism throughout the twentieth century and then was taken up again in major ways in the 1970s. I was lucky enough to be a part of that movement. When we talk about the “women’s health movement,” we are, of course, talking about many movements. We can look to the work of women who writer Susan Brownmiller has termed our “heroic antecedents,” daring women in past centuries who stood up against a culture that discouraged open speech about health problems, or who provided alternative care when none was available. We can speak specifically about the second-wave women’s movement in the 1970s and look at the foundational writings that have changed the landscape of women’s health. And we can listen to the voices of young activists who help us to understand the new issues we face today. So many of my friends recall sitting in rooms where secrets were shared among women. Typically any shameful feelings we may have had lifted as we learned that our private experiences often turned out to be universal. I remember the voices: “Yes, I had an illegal abortion.” “Yes, I was raped.” “Yes, my neighbor (brother, father, uncle, priest, doctor, therapist, teacher) hassled me sexually.” “Yes, I faked orgasms.” “Yes, every birth control method I’ve ever used was a disaster.” “Yes, my gynecologist makes me feel uncomfortable, but I can’t admit it, he’s so esteemed. His pelvic exams are so rough it hurts.” “Yes, I took a drug that made me very sick, but my doctor told me to keep taking it.” Women talked, listened, and spread the word. We went back to our communities, started our own women’s groups, consciousness-raising groups, and know-your-body courses. By 1975, there were nearly 2,000 official women’s self-help projects scattered around the United States and countless unofficial ones. Do women talk less to each other now than they did then? The very possibility is troubling. If I have a single hope for this book it is that the women who read it be inspired to talk among themselves about health, since women who talk to each other about health will go on to talk to each other about anything and everything. At the turn of the millennium, a Barnard College senior asked Judy Norsigian of Our Bodies, Ourselves what she hopes to see when the continuously updated volume celebrates its fiftieth anniversary in the year 2020. Norsigian answered, “The creation of a health and a medical care system that is far more responsive to women’s needs and accessible to all women regardless of age, income, sexual preference, race, etc. . . . And using technology in the most appropriate way—that

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is science-based, not profit-based . . .” People need to be in control of their own health. But in order for that to be possible, they must have information from a trustworthy source. I asked Cindy Pearson, executive director of the National Women’s Health Network, what she thinks about patients taking their health into their own hands. “Thirty years ago,” Pearson said, “if anyone talked about a bad experience they had with the health care system . . . the response would usually be ‘You need a better doctor. . . .’” Today, in part through the hard-won battles of consumer advocates, AIDS activists, and the feminist health movement, among others, that isn’t the only answer. Pearson continues, “People talked about finding a good doctor but then realized good doctors aren’t the answer, informed patients are the answer.” We believe that within the yin and yang of these two thoughtful responses there is to be found the right approach: good science combined with leadership from the patients’ points of view. What makes a good doctor these days isn’t always easy to say. But if there is one quality we should all be looking for in our doctors, it is the willingness to listen seriously to their patients.

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chapter 1

In the Beginning

     in New York City in the 1940s and ’50s, there was no women’s movement per se. There was, however, the memory of a women’s movement. And all around me were women who had been a part of it—suffragettes who organized and protested for the vote. My future mother-in-law, Sylvia Seaman, was one who marched to win women’s basic enfranchisement. My aunt, Gertrude Weil Klein, was a union rabble-rouser from way back who went to jail with Eugene V. Debs. When I was a child she would always marvel at how I thought women voting was normal. She chided that I couldn’t possibly appreciate it, and warned me not to forget the past despite the beautiful future I was growing up in. I think we in the now-older generation of feminists tend to get frustrated with young women because they don’t (and can’t) understand what it “was like.” It’s important to remember that it is a mark of our success—and not their failure—that they sometimes take freedoms for which we had to fight for granted. There were women in my aunt’s generation who weren’t suffragettes or part of an organized women’s movement, but who have nonetheless been amazing examples of the scope and diversity possible in female lives. My stepmother Ruth Gruber was one of these women. At the age of twenty she became the youngest person in the world to hold a PhD, and only a few years later the first American reporter of any gender to be allowed to enter the Soviet Arctic. It was women like Ruth—educated and brave, with exciting careers—for whom Betty Freidan was scouring the pages of women’s magazines when she got mad enough to write The Feminine Mystique. Betty had grown up reading stories about ambitious young women who did great things—often in the city, and often involving a career in journalism. This character disappeared after World War II to be replaced by domestic goddesses and suburban royalty. Images of independent women may have become few and far between, but they weren’t gone. And neither was the energy and widespread desire to expand rights and options for women. Both kinds of women are so important—the generations of movement women, who come 5

together in waves to make change at pivotal moments, and the strong individuals who move against the daunting tide of social injustice and backlash. Although my women’s movement wasn’t the same as Elizabeth Cady Stanton’s, they had things in common. There is continuity between generations of determined folks working for basic equality and dignity for all people. The memory of courageous individuals is part of this; it perpetuates possibility, and it opens up space for the new generation to find the issues that connect them with the past as well as the ones that are distinctly theirs. It also lets them know that achieving change is possible through example.

Witches, Midwives, and Nurses: A History of Women Healers BARBARA EHRENREICH AND DEIRDRE ENGLISH Barbara Ehrenreich and Deirdre English, Witches, Midwives, and Nurses: A History of Women Healers, New York: Feminist Press, 1973. Reprinted by permission.

Barbara Ehrenreich and Deirdre English’s Witches, Midwives, and Nurses: A History of Women Healers, a 45-page pamphlet published in 1973, revealed some of the thuggish tactics powerful males often used to oust women (and alternative providers) from medical and midwifery practice, as well as the extreme—even lunatic—treatments offered by these more formally trained physicians. Defenders of orthodox medicine dismissed and tried to discredit Barbara and Deirdre’s influential work, but a decade later, confirmation emerged in the form of a book that won the 1984 Pulitzer Prize for General Nonfiction, The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry by Princeton University sociologist Paul Starr. Starr confirmed that in the US colonies, “women were expected to deal with illness in the home and to keep a stock of remedies on hand; in the fall they put away medicinal herbs as they stored preserves.

Care of the sick was part of the domestic economy for which the wife assumed responsibility . . . in worrisome cases perhaps bringing in an older woman who had a reputation for skill with the sick.” Many guides to domestic medicine were available: “They argued that medicine was filled with unnecessary obscurity and complexity, and should be made intelligible and practicable.” In contrast to home remedies, Starr recapitulates the teachings of Dr. Benjamin Rush, the revolutionary leader, who “greatly influenced future generations of physicians at the University of Pennsylvania.” Rush maintained that there was but one disease, “morbid excitement induced by capillary tension,” and its one remedy was “to deplete the body by letting blood with the lancet and emptying out the stomach and bowels with the use of powerful emetics and cathartics. Patients could be bled until unconscious and given heavy doses of the cathartic calomel (mercurous chloride) until they salivated.” “Heroic” therapy of this type “dominated American medical practice in the first decades of the 19th century,” Starr reminds us, which helps explain why, by the 1830s, many states revoked the rights to licensure they had first granted to orthodox doctors around the time of the revolution.

 Women have always been healers. They were the unlicensed doctors and anatomists of Western history. They were abortionists, nurses, and counselors. They were pharmacists, cultivating healing herbs and exchanging the secrets of their uses. They were midwives, traveling from home to home and village to village. For centuries women were doctors without degrees, barred from books and lectures, learning from each other, and passing on experience from neighbor to neighbor and mother to daughter. They were called “wise women” by the people, witches or charlatans by the authorities. Medicine is part of our heritage as women, our history, and our birthright. Today, however, health care is the property of

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male professionals. Ninety-three percent of the doctors in the United States are men; and almost all the top directors and administrators of health institutions. Women are still in the overall majority—70 percent of health workers are women— but we have been incorporated as workers into an industry where the bosses are men. We are no longer independent practitioners, known by our own names, for our own work. We are, for the most part, institutional fixtures, filling faceless job slots: clerk, dietary aide, technician, and maid. When we are allowed to participate in the healing process, we can do so only as nurses. And nurses of every rank from aide up are just “ancillary workers” in relation to the doctors (from the Latin ancilla, maid servant). From the nurse’s aide, whose menial tasks are spelled out with industrial precision, to the “professional” nurse, who translates the doctors’ orders into the aide’s tasks, nurses share the status of a uniformed maid service to the dominant male professionals. Our subservience is reinforced by our ignorance, and our ignorance is enforced. Nurses are taught not to question, not to challenge. “The doctor knows best.” He is the shaman, in touch with the forbidden, mystically complex world of Science, which we have been taught is beyond our grasp. Women health workers are alienated from the scientific substance of their work, restricted to the “womanly” business of nurturing and housekeeping—a passive, silent majority. We are told that our subservience is biologically ordained: women are inherently nurse-like and not doctor-like. Sometimes we even try to console ourselves with the theory that we were defeated by anatomy before we were defeated by men, that women have been so trapped by the cycles of menstruation and reproduction that they have never been free and creative agents outside their homes. Another myth, fostered by conventional medical histories, is that male professionals won out on the strength of their superior technology.

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According to these accounts, (male) science more or less automatically replaced (female) superstition—which from then on was called “old wives’ tales.” But history belies these theories. Women have been autonomous healers, often the only healers for women and the poor. And we found, in the periods we have studied, that, if anything, it was the male professionals who clung to untested doctrines and ritualistic practices—and it was the woman healers who represented a more humane, empirical approach to healing. Our position in the health system today is not “natural.” It is a condition which has to be explained. In this pamphlet we have asked: How did we arrive at our present position of subservience from our former position of leadership? We learned this much: that the suppression of women health workers and the rise to dominance of male professionals was not a “natural” process, resulting automatically from changes in medical science, nor was it the result women’s failure to take on healing work. It was an active takeover by male professionals. And it was not science that enabled men to win out: The critical battles took place long before the development of modern scientific technology. The stakes of the struggle were high: Political and economic monopolization of medicine meant control over its institutional organizations, its theory and practice, its profits and prestige. And the stakes are even higher today, when total control of medicine means potential power to determine who will live and will die, who is fertile and who is sterile, who is “mad” and who sane. The suppression of female healers by the medical establishment was a political struggle, first, in that it is part of the history of sex struggle in general. The status of women healers has risen and fallen with the status of women. When women healers were attacked, they were attacked as women; when they fought back, they fought back in solidarity with all women. It was a political struggle, second, in that it

was part of a class struggle. Women healers were people’s doctors, and their medicine was part of a people’s subculture. To this very day women’s medical practice has thrived in the midst of rebellious lower-class movements which have struggled to be free from the established authorities. Male professionals, on the other hand, served the ruling class—both medically and politically. Their interests have been advanced by the universities, the philanthropic foundations, and the law. They owe their victory not so much to their own efforts, but to the intervention of the ruling class they served. This pamphlet represents a beginning of the research which will have to be done to recapture our history as health workers. It is a fragmentary account, assembled from sources which were usually sketchy and often biased, by women who are in no sense “professional” historians. We confined ourselves to Western history, since the institutions we confront today are the products of Western civilization. We are far from being able to present a complete chronological history. Instead, we looked at two separate, important phases in the male takeover of health care: the suppression of witches in medieval Europe, and the rise of the male medical profession in nineteenth-century America. To know our history is to begin to see how to take up the struggle again.

       Witches lived and were burned long before the development of modern medical technology. The great majority of them were healers serving the peasant population, and their suppression marks one of the opening struggles in the history of man’s suppression of women as healers. The other side of the suppression of witches as healers was the creation of a new male medical profession, under the protection and patronage of the ruling classes. This new European medical profession played an important role in the witch-

hunts, supporting the witches’ prosecutors with “medical” reasoning: Because the Medieval Church, with the support of kings, princes and secular authorities, controlled medical education and practice, the inquisition [witch-hunts] constitutes, among other things, an early instance of the “professional” repudiating the skills and interfering with the rights of the “nonprofessional” to minister to the poor.1 The witch-hunts left a lasting effect: An aspect of the female has ever since been associated with the witch, and an aura of contamination has remained—especially around the midwife and other women healers. This early and devastating exclusion of women from independent healing roles was a violent precedent and warning: It was to become a theme of our history. The women’s health movement of today has ancient roots in the medieval covens, and its opponents have as their ancestors those who ruthlessly forced the elimination of witches. THE WITCH CRAZE The age of witch-hunting spanned more than four centuries (from the fourteenth to the seventeenth century) in its sweep from Germany to England. It was born in feudalism and lasted— gaining in virulence—well into the “age of reason.” The witch craze took different forms at different times and places, but never lost its essential character: that of a ruling-class campaign of terror directed against the female peasant population. Witches represented a political, religious, and sexual threat to the Protestant and Catholic churches alike, as well as to the state. The extent of the witch craze is startling: In the late fifteenth and early sixteenth centuries there were thousands upon thousands of executions— usually live burnings at the stake—in Germany, Italy, and other countries. In the mid-sixteenth century the terror spread to France, and finally to England. One writer has estimated the number of executions at an average of 600 a year for certain German cities—or two a day, “leaving out Sundays.”

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Nine hundred witches were destroyed in a single year in the Wertzberg area, and 1,000 in and around Como. At Toulouse, 400 were put to death in a day. In the Bishopric of Trier, in 1585, two villages were left with only one female inhabitant each. Many writers have estimated the total number killed to have been in the millions. Women made up some 85 percent of those executed—old women, young women, and children.* Their scope alone suggests that the witch-hunts represent a deep-seated social phenomenon which goes far beyond the history of medicine. In locale and timing, the most virulent witch-hunts were associated with periods of great social upheaval shaking feudalism at its roots—mass peasant uprisings and conspiracies, the beginnings of capitalism, the rise of Protestantism. There is fragmentary evidence—which feminists ought to follow up—suggesting that in some areas witchcraft represented a female-led peasant rebellion. Here we can’t attempt to explore the historical context of the witch-hunts in any depth. But we do have to get beyond some common myths about the witch craze—myths which rob the “witch” of any dignity and put blame on her and the peasants she served. Unfortunately, the witch herself—poor and illiterate—did not leave us her story. It was recorded, like all history, by the educated elite, so today we know the witch only through the eyes of her persecutors. Two of the most common theories of the witchhunts are basically medical interpretations, attributing the witch craze to unexplainable outbreaks of mass hysteria. One version has it that the peasantry went mad. According to this, the witch craze was an epidemic of mass hatred and panic cast in images of a blood-lusty peasant bearing flaming torches. Another psychiatric interpretation holds that the witches themselves were insane. . . .

But, in fact, the witch craze was neither a lynching party nor a mass suicide by hysterical women. Rather, it followed well-ordered, legalistic procedures. The witch-hunts were well-organized campaigns, initiated, financed, and executed by church and state. To Catholic and Protestant witch-hunters alike, the unquestioned authority on how to conduct a witch-hunt was the Malleus Maleficarum or Hammer of Witches, written in 1487 by the Reverends Kramer and Sprenger (the “beloved sons” of Pope Innocent VIII). For three centuries this sadistic book lay on the bench of every judge, every witchhunter. In a long section on judicial proceedings, the instructions make it clear how the “hysteria” was set off: The job of initiating a witch trial was to be performed by either the vicar (priest) or judge of the county. . . . Anyone failing to report a witch faced both excommunication and a long list of temporal punishments. . . . Kramer and Sprenger gave detailed instructions about the use of tortures to force confessions and further accusations. Commonly, the accused was stripped naked and shaved of all her body hair, then subjected to thumbscrews and the rack, spikes and bone-crushing “boots,” starvation and beatings. The point is obvious: The witch craze did not arise spontaneously in the peasantry. It was a calculated ruling-class campaign of terrorization. THE CRIMES OF THE WITCHES Who were the witches, then, and what were their “crimes” that could arouse such vicious upper-class suppression? . . . Three central accusations emerge repeatedly in the history of witchcraft throughout northern Europe: First, witches are accused of every conceivable sexual crime against men. Quite simply, they are “accused” of female sexuality. Second, they are

*We are omitting from this discussion any mention of the New England witch trials in the 1600s. These trials occurred on a relatively small scale, very late in the history of witch-hunts, and in an entirely different social context than the earlier European witch craze.

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accused of being organized. Third, they are accused of having magical powers affecting health—of harming, but also of healing. They were often charged specifically with possessing medical and obstetrical skills. First, consider the charge of sexual crimes. The medieval Catholic church elevated sexism to a point of principle: the Malleus declares, “When a woman thinks alone, she thinks evil.” The misogyny of the church, if not proved by the witch craze itself, is demonstrated by its teaching that in intercourse the male deposits in the female a homunculus, or “little person,” complete with soul, which is simply housed in the womb for nine months, without acquiring any attributes of the mother. The homunculus is not really safe, however, until it reaches male hands again, when a priest baptizes it, ensuring the salvation of its immortal soul. Another depressing fantasy of some medieval religious thinkers was that upon resurrection all human beings would be reborn as men! The church associated women with sex, and all pleasure in sex was condemned, because it could only come from the devil. Witches were supposed to have gotten pleasure from copulation with the devil (despite the icy-cold organ he was reputed to possess) and they in turn infected men. Lust in either man or wife, then, was blamed on the female. On the other hand, witches were accused of making men impotent and of causing their penises to disappear. As for female sexuality, witches were accused, in effect, of giving contraceptive aid and of performing abortions: Now there are, as it is said in the Papal Bull, seven methods by which they infect with witchcraft the venereal act and the conception of the womb: First, by inclining the minds of men to inordinate passion; second, by obstructing their generative force; third, by removing the members accommodated to that act; fourth, by changing men into beasts by their magic act; fifth, by destroying the generative in women;

sixth, by procuring abortion; seventh, by offering children to the devils, besides other animals and fruits of the earth with which they work much harm. . . .2 In the eyes of the church, all the witch’s power was ultimately derived from her sexuality. Her career began with sexual intercourse with the devil. Each witch was confirmed at a general meeting (the witches’ sabbath) at which the devil presided, often in the form of a goat, and had intercourse with the neophytes. In return for her powers, the witch promised to serve him faithfully. (In the imagination of the church even evil could only be thought of as ultimately male-directed!) As the Malleus makes clear, the devil almost always acts through the female, just as he did in Eden: All witchcraft comes from carnal lust, which in women is insatiable. . . . Wherefore for the sake of fulfilling their lusts they consort with devils . . . it is sufficiently clear that it is no matter for wonder that there are more women than men found infected with the heresy of witchcraft. . . . And blessed be the Highest Who has so far preserved the male sex from so great a crime. . . . Not only were the witches women, they were women who seemed to be organized into an enormous secret society. A witch who was a proved member of the “devil’s party” was more dreadful than one who had acted alone, and the witchhunting literature is obsessed with the question of what went on at the witches’ “sabbaths.” (Eating of unbaptised babies? Bestialism and mass orgies? So went their lurid speculations. . . .) In fact, there is evidence that women accused of being witches did meet locally in small groups and that these groups came together in crowds of hundreds or thousands on festival days. Some writers speculate that the meetings were occasions for trading herbal lore and passing on the news. We have little evidence about the political significance of the witches’ organizations, but it’s hard

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to imagine that they weren’t connected to the peasant rebellions of the time. Any peasant organization, just being an organization, would attract dissidents, increase communication between villages, and build a spirit of collectivity and autonomy among the peasants. WITCHES AS HEALERS We come now to the most

fantastic accusation of all. The witch is accused not only of murdering and poisoning, sex crimes and conspiracy, but of helping and healing. . . . Witch-healers were often the only general medical practitioners for a people who had no doctors and no hospitals and who were bitterly afflicted with poverty and disease. In particular, the association of the witch and the midwife was strong: “No one does more harm to the Catholic church than midwives,” wrote witch-hunters Kramer and Sprenger. . . . When faced with the misery of the poor, the church turned to the dogma that experience in this world is fleeting and unimportant. But there was a double standard at work, for the church was not against medical care for the upper class. Kings and nobles had their court physicians, who were men, sometimes even priests. The real issue was control: Male upper-class healing under the auspices of the church was acceptable; female healing as part of a peasant subculture was not. The church saw its attack on peasant healers as an attack on magic, not medicine. The devil was believed to have real power on earth, and the use of that power by peasant women—whether for good or evil—was frightening to the church and state. The greater their satanic powers to help themselves, the less they were dependent on God and the church and the more they were potentially able to use their powers against God’s order. Magic charms were thought to be at least as effective as prayer in healing the sick, but prayer was church-sanctioned and controlled while incantations and charms were not. Thus magic cures, even when successful, were an accused interference with the will of God, achieved

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with the help of the devil, and the cure itself was evil. There was no problem in distinguishing God’s cures from the devil’s, for obviously the Lord would work through priests and doctors rather than through peasant women. The wise woman, or witch, had a host of remedies which had been tested in years of use. Many of the herbal remedies developed by witches still have their place in modern pharmacology. They had painkillers, digestive aids, and anti-inflammatory agents. They used ergot for the pain of labor at a time when the church held that pain in labor was the Lord’s just punishment for Eve’s original sin. Ergot derivatives are the principal drugs used today to hasten labor and aid in the recovery from childbirth. Belladonna—still used today as an antispasmodic—was used by the witch-healers to inhibit uterine contractions when miscarriage threatened. Digitalis, still an important drug in treating heart ailments, is said to have been discovered by an English witch. . . . The witch-healer’s methods were as great a threat (to the Catholic Church, if not Protestant) as her results, for the witch was an empiricist: She relied on her senses rather than on faith or doctrine, she believed in trial and error, cause and effect. Her attitude was not religiously passive, but actively inquiring. She trusted her ability to find ways to deal with disease, pregnancy, and childbirth— whether through medications or charms. In short, her magic was the science of her time. The church, by contrast was deeply anti-empirical. It discredited the value of the material world and had a profound distrust of the senses. There was no point in looking for natural laws that govern physical phenomena, for the world is created anew by God in every instant. Kramer and Sprenger, in the Malleus, quote St. Augustine on the deceptiveness of the senses: Now the motive of the will is something perceived through the senses or the intellect, both of which are subject to the power of the devil. . . .

The senses are the devil’s playground, the arena into which he will try to lure men away from Faith and into the conceits of the intellect or the delusions of carnality. In the persecution of the witch, the anti-empiricist and misogynist antisexual obsessions of the church coincide: Empiricism and sexuality both represent a surrender to the senses, a betrayal of faith. The witch was a triple threat to the church: She was a woman, and not ashamed of it. She appeared to be part of an organized underground of peasant women. And she was a healer whose practice was based in empirical study. In the face of the repressive fatalism of Christianity, she held out the hope of change in this world. THE RISE OF THE EUROPEAN MEDICAL PROFESSION

While witches practiced among the people, the ruling classes were cultivating their own breed of secular healers: the university-trained physicians. In the century that preceded the beginning of the “witch craze”—the thirteenth century—European medicine became firmly established as a secular science and a profession. The medical profession was actively engaged in the elimination of female healers—their exclusion from the universities, for example—long before the witchhunts began. For eight long centuries, from the fifth to the thirteenth, the otherworldly, antimedical stance of the church had stood in the way of the development of medicine as a respectable profession. Then, in the thirteenth century, there was a revival of learning, touched off by contact with the Arab world. Medical schools appeared in the universities, and more and more young men of means sought medical training. The church imposed strict controls on the new profession, and allowed it to develop only within the terms set by Catholic doctrine. University-trained physicians were not permitted to practice without calling in a priest to aid and advise them, or to treat a patient who refused confession. By the fourteenth century their practice was in demand among the wealthy,

as long as they continued to take pains to show that their attentions to the body did not jeopardize the soul. In fact, accounts of their medical training make it seem more likely that they jeopardized the body. There was nothing in late medieval medical training that conflicted with church doctrine, and little that we would recognize as “science.” Medical students, like other scholarly gentlemen, spent years studying Plato, Aristotle, and Christian theology. Their medical theory was largely restricted to the works of Galen, the ancient Roman physician who stressed the theory of “complexions” or “temperaments” of men, “wherefore the choleric are wrathful, the sanguine are kindly, the melancholy are envious,” and so on. While a student, a doctor rarely saw any patients at all, and no experimentation of any kind was taught. Medicine was sharply differentiated from surgery, which was almost everywhere considered a degrading, menial craft, and the dissection of bodies was almost unheard of. Confronted with a sick person, the universitytrained physician had little to go on but superstition. Bleeding was a common practice, especially in the case of wounds. Leeches were applied according to the time, the hour, the air, and other similar considerations. Medical theories were often grounded more in “logic” than in observation: “Some foods brought on good humors, and others, evil humors. For example, nasturtium, mustard, and garlic produced reddish bile; lentils, cabbage, and the meat of old goats and beeves begot black bile.” Incantations, and quasi-religious rituals were thought to be effective: The physician to Edward II, who held a bachelor’s degree in theology and a doctorate in medicine from Oxford, prescribed for toothache writing on the jaws of the patient, “In the name of the Father, the Son, and the Holy Ghost, Amen,” or touching a needle to a caterpillar and then to the tooth. . . . Such was the state of medical “science” at the time when witch-healers were persecuted for being practitioners of “magic.” It was witches who de-

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veloped an extensive understanding of bones and muscles, herbs and drugs, while physicians were still deriving their prognoses from astrology and alchemists were trying to turn lead into gold. So great was the witches’ knowledge that in 1527, Paracelsus, considered the “father of modern medicine,” burned his text on pharmaceuticals, confessing that he “had learned from the Sorceress all he knew.” THE SUPPRESSION OF WOMEN HEALERS The estab-

lishment of medicine as a profession requiring university training made it easy to bar women legally from practice. With few exceptions, the universities were closed to women (even to upperclass women who could afford them), and licensing laws were established to prohibit all but university-trained doctors from practice. It was impossible to enforce the licensing laws consistently since there was only a handful of university-trained doctors compared to the great mass of lay healers. But the laws could be used selectively. Their first target was not the peasant healer, but the better-off, literate woman healer who competed for the same urban clientele as that of the university-trained doctors. Take, for example, the case of Jacoba Félicie, brought to trial in 1322 by the Faculty of Medicine at the University of Paris, on charges of illegal practice. Jacoba was literate and had received some unspecified “special training” in medicine. That her patients were well off is evident from the fact that (as they testified in court) they had consulted well-known university-trained physicians before turning to her. The primary accusations brought against her were that . . . she would cure her patient of internal illness and wounds or of external abscesses. She would visit the sick assiduously and continue to examine the urine in the manner on physicians, feel the pulse, and touch the body and limbs. Six witnesses affirmed that Jacoba had cured

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them, even after numerous doctors had given up, and one patient declared that she was wiser in the art of surgery and medicine than any master physician or surgeon in Paris. But these testimonials were used against her, for the charge was not that she was incompetent, but that—as a woman— she dared to cure at all. Along the same lines, English physicians sent a petition to Parliament bewailing the “worthless and presumptuous women who usurped the profession” and asking the imposition of fines and “long imprisonment” on any woman who attempted to “use the practyse of Fisyk.” By the fourteenth century, the medical profession’s campaign against urban, educated women healers was virtually complete throughout Europe. Male doctors had won a clear monopoly over the practice of medicine among the upper classes (except for obstetrics, which remained the province of female midwives even among the upper classes for another three centuries). They were ready to take a key role in the elimination of the great mass of female healers—the “witches.” The partnership between church, state, and medical profession reached full bloom in the witch trials. The doctor was held up as the medical “expert,” giving an aura of science to the whole proceeding. He was asked to make judgments about whether certain women were witches and whether certain afflictions had been caused by witchcraft. The Malleus says: “And if it is asked how it is possible to distinguish whether an illness is caused by witchcraft or by some natural physical defect, we answer that the first [way] is by means of the judgment of doctors” [emphasis added]. In the witch-hunts, the church explicitly legitimized the doctors’ professionalism, denouncing nonprofessional healing as equivalent to heresy: “If a woman dare to cure without having studied, she is a witch and must die.” . . . The distinction between “female” superstition and “male” medicine was made final by the very roles of the doctor and the witch at the trial. The trial in one stroke established the male physician

on a moral and intellectual plane vastly above the female healer he was called to judge. It placed him on the side of God and law, a professional on par with lawyers and theologians, while it placed her on the side of darkness, evil, and magic. He owed his new status not to medical school or scientific achievements of his own, but to the church and state he served so well. THE AFTERMATH Witch-hunts did not eliminate the

lower-class woman healer, but they branded her forever as superstitious and possibly malevolent. So thoroughly was she discredited among the emerging middle classes that in the seventeenth and eighteenth centuries it was possible for male practitioners to make serious inroads into that last preserve of female healing—midwifery. Nonprofessional male practitioners—“barber-surgeons”— led the assault in England, claiming technical superiority on the basis of their use of the obstetrical forceps. (The forceps were legally classified as a surgical instrument, and women were legally barred from surgical practice.) In the hands of the barber-surgeons, obstetrical practice among the middle class was quickly transformed from a neighborly service into a lucrative business, which real physicians entered in force in the late eighteenth century. Female midwives in England organized and charged the male intruders with commercialism and dangerous misuse of the forceps. But it was too late— the women were easily put down as ignorant “old wives” clinging to the superstitions of the past.

         In the United States, the male takeover of healing roles started later than in England or France, but ultimately went much further. . . . By the turn of the century, medicine here was closed to all but a tiny minority of necessarily tough and well-heeled women. What was left was nursing, and this was in no way a substitute for the autonomous roles women had enjoyed as midwives and general healers.

The question is not so much how women got “left out” of medicine and left with nursing, but how did these categories arise at all? To put it another way: How did one particular set of healers, who happened to be male, white, and middle-class, manage to oust all the competing folk healers, midwives, and other practitioners who had dominated the American medical scene in the early 1800s? The conventional answer given by medical historians is, of course, that there always was one true American medical profession—a small band of men whose scientific and moral authority flowed in a unbroken stream from Hippocrates, Galen, and the great European medical scholars. In frontier America these doctors had to combat not only the routine problems of sickness and death but the abuses of a host of lay practitioners—usually depicted as women, ex-slaves, Indians, and drunken patent medicine salesmen. Fortunately for the medical profession, in the late nineteenth century the American public suddenly developed a healthy respect for the doctors’ scientific knowledge, outgrew its earlier faith in quacks, and granted the true medical profession a lasting monopoly of the healing arts. But the real answer is not in this made-up drama of science versus ignorance and superstition. It’s part of the nineteenth century’s long story of class and sex struggles for power in all areas of life. When women had a place in medicine, it was in a people’s medicine. When that people’s medicine was destroyed, there was no place for women—except in the subservient role of nurses. The set of healers who became the medical profession was distinguished not so much by its associations with modern science as by its associations with the emerging American business establishment. With all due respect to Pasteur, Koch, and the other great European medical researchers of the nineteenth century, it was the Carnegies and the Rockefellers who intervened to secure the final victory of the American medical profession. . . .

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In western Europe, university-trained physicians already had a centuries-old monopoly over the right to heal. But in America, medical practice was traditionally open to anyone who could demonstrate healing skills—regardless of formal training, race, or sex. Ann Hutchinson, the dissenting religious leader of the 1600s, was a practitioner of “general physik,” as were many other ministers and their wives. The medical historian Joseph Kett reports that “one of the most respected medical men in the late eighteenth century Windsor, Connecticut, for example, was a freed Negro called ‘Dr. Primus.’ In New Jersey, medical practice, except in extraordinary cases, was mainly in the hands women as late as 1818.” Women frequently went into joint practices with their husbands: the husband handling the surgery, the wife the midwifery and gynecology, and everything else shared. Or a woman might go into practice after developing skills through caring for family members or through an apprenticeship with a relative or other established healer. . . . ENTER THE DOCTOR In the early 1800s there was also a growing number of formally trained doctors who took great pains to distinguish themselves from the host of lay practitioners. The most important real distinction was that the formally trained, or “regular” doctors, as they called themselves, were male, usually middle-class, and almost always more expensive than the lay competition. The regulars’ practices were largely confined to middle- and upper-class people who could afford the prestige of being treated by a “gentlemen” of their own class. By 1800, fashion even dictated that upper- and middle-class women employ male regular doctors for obstetrical care—a custom which plainer people regarded as grossly indecent. In terms of medical skills and theory, the socalled regulars had nothing to recommend them over the lay practitioners. Their “formal training” meant little even by European standards of the time: Medical programs varied in length from a

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few months to two years; many medical schools had no clinical facilities; high school diplomas were not required for admission to medical schools. Not that serious academic training would have helped much anyway—there was no body of medical science to be trained in. Instead, the regulars were taught to treat most ills by “heroic” measures: massive bleeding, huge doses of laxatives, calomel (a laxative containing mercury) and, later, opium. (The European medical profession had little better to offer at this time.) There is no doubt that these “cures” were often either fatal or more injurious than the original disease. . . . The lay practitioners were undoubtedly safer and more effective than the regulars. They preferred mild herbal medications, dietary changes, and hand-holding to heroic interventions. Maybe they didn’t know any more than the regulars, but at least they were less likely to do the patient harm. Left alone, they might well have displaced the regular doctors with even middle-class consumers in time. But they didn’t know the right people. The regulars, with their close ties to the upper class, had legislative clout. By 1830, 13 states had passed medical licensing laws outlawing “irregular” practice and establishing the regulars as the only legal healers. It was a premature move. There was not popular support for the idea of medical professionalism, much less for the particular set of healers who claimed it. And there was no way to enforce the new laws. The trusted healers of the common people could not just be legislated out of practice. Worse still for the regulars, this early grab for medical monopoly inspired mass indignation in the form of a radical, popular health movement which came close to smashing medical elitism in America once and for all. THE POPULAR HEALTH MOVEMENT The popular

health movement of the 1830s and 1840s is usually dismissed in conventional medical histories as the high tide of quackery and medical cultism. In reality it was the medical front of a general social

upheaval stirred up by feminist and working-class movements. Women were the backbone of the popular health movement. “Ladies’ Physiological Societies,” the equivalent of our know-your-body courses, sprang up everywhere, bringing rapt audiences simple instructions in anatomy and personal hygiene. The emphasis was on preventive care, as opposed to the murderous “cures” practiced by the regular doctors. The movement ran up the banner for frequent bathing (regarded as a vice by many regular doctors of the time), loose-fitting female clothing, whole-grain cereals, temperance, and a host of other issues women could relate to. And, at about the time Margaret Sanger’s mother was a little girl, some elements of the movement were already pushing birth control. The movement was a radical assault on medical elitism and an affirmation of the traditional people’s medicine. “Every man his own doctor,” was the slogan of one wing of the movement, and they made it very clear that they meant every woman too. The regular, licensed, doctors were attacked as members of “parasitic, non-producing classes,” who survived only because of the upper class’s “lurid taste” for calomel and bleeding. Universities (where the elite of the regular doctors were trained) were denounced as places where students “learn to look upon labor as servile and demeaning” and to identify with the upper class. Working-class radicals rallied to the cause, linking “King-craft, Priestcraft, Lawyer-craft, and Doctor-craft” as the four great evils of the time. In New York State, the movement was represented in the legislature by a member of the Workingmen’s Party, who took every opportunity to assail the “privileged doctors.” The regular doctors quickly found themselves outnumbered and cornered. From the left wing of the popular health movement came a total rejection of “doctoring” as a paid occupation—much less as an overpaid “profession.” From the moderate wing came a host of new medical philosophies, or sects to compete with the regulars on their own terms: eclecticism, Grahamism, homeopathy, plus many minor ones. The new sects set up their

own medical schools (emphasizing preventive care and mild herbal cures), and started graduating their own doctors. In this context of medical ferment, the old regulars began to look like just another sect, a sect whose particular philosophy happened to lean toward calomel, bleeding, and the other standbys of “heroic” medicine. It was impossible to tell who were the “real” doctors, and by the 1840s, medical licensing laws had been repealed in almost all of the states. The peak of the popular health movement coincided with the beginnings of an organized feminist movement, and the two were so closely linked that it’s hard to tell where one began and the other left off. “This crusade for women’s health [the popular health movement] was related both in cause and effect to the demand for women’s rights in general, and at the health and feminist movements become indistinguishable at this point,” according to Richard Shryock, the well-known medical historian. The health movement was concerned with women’s rights in general, and the women’s movement was particularly concerned with health and with women’s access to medical training. In fact, leaders of both groups used the prevailing sex stereotypes to argue that women were even better equipped to be doctors than men. “We cannot deny that women possess superior capacities for the science of medicine,” wrote Samuel Thomson, a health movement leader, in 1834. (However, he felt surgery and the care of males should be reserved for male practitioners.) Feminists, like Sarah Hale, went further, exclaiming in 1852: “Talk about this [medicine] being the appropriate sphere for man and his alone! With tenfold more plausibility and reason we say it is the appropriate sphere for woman, and hers alone.” The new medical sects’ schools did, in fact, open their doors to women at a time when regular medical training was all but closed to them. For example, Harriet Hunt was denied admission to Harvard Medical College, and instead went to a sectarian school for her formal training. (Actually,

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the Harvard faculty had voted to admit her—along with some black male students—but the students threatened to riot if they came.) The regular physicians could take the credit for training Elizabeth Blackwell, America’s first female “regular,” but her alma mater (a small school in upstate New York) quickly passes a resolution barring further female students. The first generally co-ed medical schools was the “irregular” Eclectic Central Medical College of New York, in Syracuse. Finally, the first two allfemale medical colleges, one in Boston and one in Philadelphia, were themselves “irregular.” Feminist researchers should really find out more about the popular health movement. From the perspective of our movement today, it’s probably more relevant than the women’s suffrage struggle. To us, the most tantalizing aspects of the movement are: 1. That it represented both class struggle and feminist struggle. Today it’s stylish in some quarters to write off purely feminist issues as middleclass concerns. But in the popular health movement we see a coming together of feminist and working-class energies. Is this because the popular health movement naturally attracted dissidents of all kinds, or was there some deeper identity of purpose? 2. It was not just a movement for more and better medical care, but for a radically different kind of health care: It was a substantive challenge to the prevailing medical dogma, practice, and theory. Today we tend to confine our critiques to the organization of medical care and assume that the scientific substratum of medicine is unassailable. We too should be developing the capability for the critical study of medical “science”—at least as it relates to women. DOCTORS ON THE OFFENSIVE At its height in the

1830s and 1840s, the popular health movement had the regular doctors—the professional ancestors of today’s physicians—running scared. Later in the nineteenth century, as the grassroots energy

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ebbed and the movement degenerated into a set of competing sects, the regulars went back on the offensive. In 1848, they pulled together their first national organization, pretentiously named the American Medical Association (AMA). County and state medical societies, many of which had practically disbanded during the height of medical anarchy in the 1830s and 1840s, began to re-form. Throughout the latter part of the nineteenth century, the regulars relentlessly attacked lay practitioners, sectarian doctors, and women practitioners in general. The attacks were linked: Women practitioners could be attacked because of their sectarian leanings; sects could be attacked because of their openness to women. The arguments against women doctors ranged from the paternalistic (how could a respectable woman travel at night to a medical emergency?) to the hard-core sexist. . . . The virulence of the American sexist opposition to women in medicine has no parallel in Europe. This is probably because, first, fewer European women were aspiring to medical careers at this time. Second, feminist movements were nowhere as strong as in the United States, and here the male doctors rightly associated the entrance of women into medicine with organized feminism. And, third, the European medical profession was already more firmly established and hence less afraid of competition. The rare woman who did make it into a regular medical school faced one sexist hurdle after another. First, there was the continuous harassment—often lewd—by the male students. There were professors who wouldn’t discuss anatomy with a lady present. . . . Having completed her academic work, the wouldbe woman doctor usually found the next steps blocked. Hospitals were usually closed to women doctors, and even if they weren’t, the internships were not open to women. If she finally did make it into practice, she found her brother “regulars” unwilling to refer patients to her and absolutely opposed to her membership in their medical societies. And so it is all the stranger to us, and all the

sadder, that what we might call the “women’s health movement” began, in the late nineteenth century, to dissociate itself from its popular health movement past and to strive for respectability. Members of irregular sects were purged from the faculties of the women’s medical colleges. Female medical leaders such as Elizabeth Blackwell joined male “regulars” in demanding an end to lay midwifery and “a complete medical education” for all who practiced obstetrics. All this at a time when the regulars still had little or no “scientific” advantage over the sect doctors or lay healers. The explanation, we suppose, was that the women who were likely to seek formal medical training at this time were middle-class. They must have found it easier to identify with the middleclass regular doctors than with lower-class women healers or with the sectarian medical groups (which had earlier been identified with radical movements). The shift in allegiance was probably made all the easier by the fact that, in the cities, female lay practitioners were increasingly likely to be immigrants. (At the same time, the possibilities for a cross-class women’s movement on any issue were vanishing as working-class women went into the factories and middle-class women settled into Victorian ladyhood.) Whatever the exact explanation, the result was that middle-class women had given up the substantive attack on male medicine, and accepted the terms set by the emerging male medical profession. PROFESSIONAL VICTORY The regulars were still in no condition to make another bid for medical monopoly. For one thing, they still couldn’t claim to have any uniquely effective methods or special body of knowledge. Besides, an occupational group doesn’t gain a professional monopoly on the basis of technical superiority alone. A recognized profession is not just a group of self-proclaimed experts; it is a group which has authority in the law to select its own members and regulate their practice, i.e., to monopolize a certain field without outside interference. How does a particular group

gain full professional status? In the words of sociologist Elliot Freidson: A profession attains and maintains its position by virtue of the protection and patronage of some elite segment of society which has been persuaded that there is some special value in its work. In other words, professions are the creation of a ruling class. To become the medical profession, the regular doctors needed above all, ruling-class patronage. By a lucky coincidence for the regulars, both the science and the patronage became available around the same time, at the turn of the century. French and especially German scientists brought forth the germ theory of disease which provided, for the first time in human history, a rational basis for disease prevention and therapy. While the runof-the-mill American doctor was still mumbling about “humors” and dosing people with calomel, a tiny medical elite was traveling to German universities to learn the new science. They returned to the United States filled with reformist zeal. In 1893 German-trained doctors (funded by local philanthropists) set up the first . . . German-style medical school, Johns Hopkins. As far as curriculum was concerned, the big innovation at Hopkins was integrating lab work in basic science with expanded clinical training. Other reforms included hiring full-time faculty, emphasizing research, and closely associating the medical school with a full university. Johns Hopkins also introduced the modern pattern of medical education—four years of medical school following four years of college—which of course barred most working-class and poor people from the possibility of a medical education. Meanwhile the United States was emerging as the industrial leader of the world. Fortunes built on oil, coal, and the ruthless exploitation of American workers were maturing into financial empires. For the first time in American history, there were sufficient concentrations of corporate wealth to allow

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for massive organized philanthropy, i.e., organized ruling-class intervention in the social, cultural, and political life of the nation. Foundations were created as the lasting instrument of this intervention—the Rockefeller and Carnegie foundations appeared in the first decade of the twentieth century. One of the earliest and highest items on their agenda was medical “reform,” the creation of a respectable, scientific American medical profession. The group of American medical practitioners that the foundations chose to put their money behind was, naturally enough, the scientific elite of the regular doctors. (Many of these men were themselves ruling-class, and all were urbane, university-trained gentlemen.) Starting in 1903, foundation money began to pour into medical schools by the millions. The conditions were clear: conform to the Johns Hopkins model or close. To get the message across, the Carnegie Corporation sent a staff man, Abraham Flexner, out on a national tour of medical schools—from Harvard right down to the last third-rate commercial schools. Flexner almost singlehandedly decided which schools would get the money—and hence survive. For the bigger and better schools (i.e., those which already had enough money to begin to institute the prescribed reforms), there was the promise of fat foundation grants. Harvard was one of the lucky winners, and its president could say smugly in 1907, “Gentlemen, the way to get endowments for medicine is to improve medical education.” As for the smaller, poorer schools, which included most of the sectarian schools and special schools for blacks and women—Flexner did not consider them worth saving. Their options were to close, or to remain open and face public denunciation in the report Flexner was preparing. The Flexner report, published in 1910, was the foundations’ ultimatum to American medicine. In its wake, medical schools closed by the score, including six of America’s eight black medical schools and the majority of the “irregular” schools which had been a haven for female students. Medicine was established once and for all as a branch of

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“higher” learning, accessible only through lengthy and expensive university training. It’s certainly true that as medical knowledge grew, lengthier training did become necessary. But Flexner and the foundations had no intention of making such training available to the great mass of lay healers and “irregular” doctors. Instead, doors were slammed shut to blacks, to the majority of women, and to poor white men. (Flexner in his report bewailed the fact that any “crude boy or jaded clerk” had been able to seek medical training.) Medicine had become a white, male, middle-class occupation. But it was more than an occupation. It had become, at last, a profession. To be more precise, one particular group of healers, the regular doctors, was now the medical profession. Their victory was not based on any skills of their own: the run-ofthe-mill regular doctor did not suddenly acquire a knowledge of medical science with the publication of the Flexner report. But he did acquire the mystique of science. So what if his own alma mater had been condemned in the Flexner report, wasn’t he a member of the AMA, and wasn’t it in the forefront of scientific reform? The doctor had become—thanks to some foreign scientists and eastern foundations— the “man of science”: beyond criticism, beyond regulation, very nearly beyond competition. OUTLAWING THE MIDWIVES In state after state, new,

tough, licensing laws sealed the doctor’s monopoly on medical practice. All that was left was to drive out the last holdouts of the old people’s medicine—the midwives. In 1910, about 50 percent of all babies were delivered by midwives—most were blacks or working-class immigrants. It was an intolerable situation to the newly emerging obstetrical specialty. For one thing, every poor woman who went to a midwife was one more case lost to academic teaching and research. America’s vast lower-class resource of obstetrical “teaching material” was being wasted on ignorant midwives. Besides which, poor women were spending an estimated $5 million a year on midwives—$5 million which could have been going to “professionals.”

Publicly, however, the obstetricians launched their attacks on midwives in the name of science and reform. Midwives were ridiculed as “hopelessly dirty, ignorant and incompetent.” Specifically, they were held responsible for the prevalence of puerperal sepsis (uterine infections) and neonatal ophthalmia (blindness due to parental infection with gonorrhea). Both conditions were easily preventable by techniques well within the grasp of the least literate midwife (hand-washing for puerperal sepsis, and eye drops for the ophthalmia). So the obvious solution for a truly public-spirited obstetrical profession would have been to make the appropriate preventive techniques known and available to the mass of midwives. This is in fact what happened in England, Germany, and most other European nations: Midwifery was upgraded through training to become an established, independent occupation. But the American obstetricians had no real commitment to improved obstetrical care. In fact, a study by a Johns Hopkins professor in 1912 indicated that most American doctors were less competent than the midwives. Not only were the doctors themselves unreliable about preventing sepsis and ophthalmia but they also tended to be too ready to use surgical techniques that endangered mother or child. If anyone, then, deserved a legal monopoly on obstetrical care, it was the midwives, not the MDs. But the doctors had power, the midwives didn’t. Under intense pressure from the medical profession, state after state passed laws outlawing midwifery and restricting the practice of obstetrics to doctors. For poor and workingclass women, this actually meant worse—or no— obstetrical care. (For instance, a study of infant mortality rates in Washington showed an increase in infant mortality in the years immediately following the passage of the law forbidding midwifery.) For the new, male medical profession, the ban on midwives meant one less source of competition. Women had been routed from their last foothold as independent practitioners.

THE LADY WITH THE LAMP The only remaining oc-

cupation for women in health was nursing. Nursing had not always existed as a paid occupation—it had to be invented. In the early nineteenth century, a “nurse” was simply a woman who happened to be nursing someone—a sick child or an aging relative. There were hospitals, and they did employ nurses. But the hospitals of the time served largely as refuges for the dying poor, with only token care provided. Hospital nurses, history has it, were a disreputable lot, prone to drunkenness, prostitution, and thievery. And conditions in the hospitals were often scandalous. In the late 1870s a committee investigating New York’s Bellevue Hospital could not find a bar of soap on the premises. If nursing was not exactly an attractive field to women workers, it was a wide open arena for women reformers. To reform hospital care, you had to reform nursing, and to make nursing acceptable to doctors and to women “of good character,” it had to be given a completely new image. Florence Nightingale got her chance in the battle-front hospitals of the Crimean War, where she replaced the old camp-follower “nurses” with a bevy of disciplined, sober, middle-aged ladies. Dorothea Dix, an American hospital reformer, introduced the new breed of nurses in the Union hospitals of the Civil War. The new nurse—“the lady with the lamp,” selflessly tending the wounded —caught the popular imagination. Real nursing schools began to appear in England right after the Crimean War, and in the United States right after the Civil War. At the same time, the number of hospitals began to increase to keep pace with the needs of medical education. Medical students needed hospitals to train in; good hospitals, as the doctors were learning, needed good nurses. In fact, the first American nursing schools did their best to recruit actual upper-class women as students. Miss Euphemia Van Rensselear, of an old aristocratic New York family, graced Bellevue’s first class. And at Johns Hopkins, where Isabel Hampton trained nurses in the University Hospital, a leading doctor could only complain that:

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Miss Hampton has been most successful in getting probationers [students] of the upper class; but unfortunately, she selects them altogether for their good looks and the House staff is by this time in a sad state. Let us look a little more closely at the women who invented nursing, because, in a very real sense, nursing as we know it today is the product of their oppression as upper-class Victorian women. Dorothea Dix was an heiress of substantial means. Florence Nightingale and Louisa Schuyler (the moving force behind the creation of America’s first Nightingale-style nursing school) were genuine aristocrats. They were refugees from the enforced leisure of Victorian ladyhood. Dix and Nightingale did not begin to carve out their reform careers until they were in their thirties, and faced with the prospect of a long, useless spinsterhood. They focused their energies on the care of the sick because this was a “natural” and acceptable interest for ladies of their class. Nightingale and her immediate disciples left nursing with the indelible stamp of their own class biases. Training emphasized character, not skills. The finished products, the Nightingale nurse, was simply the ideal lady, transplanted from home to the hospital and absolved of reproductive responsibilities. To the doctor, she brought the wifely virtue of absolute obedience. To the patient, she brought the selfless devotion of a mother. To the lower level hospital employees, she brought the firm but kindly discipline of a household manager accustomed to dealing with servants. But, despite the glamorous “lady with the lamp” image, most of nursing work was just low-paid, heavy-duty housework. Before long, most nursing schools were attracting only women from working-class and lower-middle-class homes, whose only other options were factory or clerical work. But the philosophy of nursing education did not change—after all, the educators were still middle- and upper-class women. If anything, they toughened their insistence on ladylike character CHAPTER 1: IN TH E BEG INNING

development, and the socialization of nurses became what it has been for most of the twentieth century: the imposition of upper-class cultural values on working-class women. (For example, until recently, most nursing students were taught such upper-class graces as tea pouring, art appreciation, etc. Practical nurses are still taught to wear girdles, use makeup, and in general mimic the behavior of a “better” class of women.) But the Nightingale nurse was not just the projection of upper-class ladyhood onto the working world. She embodied the very spirit of femininity as defined by sexist Victorian society—she was Woman. The inventors of nursing saw it as a natural vocation for women, second only to motherhood. When a group of English nurses proposed that nursing model itself after the medical profession, with exams and licensing, Nightingale responded that “nurses cannot be registered and examined any more than mothers” [emphasis added]. Or, as one historian of nursing put it, nearly a century later, “Woman is an instinctive nurse, taught by Mother Nurse” (Victor Robinson, White Caps: The Story of Nursing). If women were instinctive nurses, they were not, in the Nightingale view, instinctive doctors. She wrote of the few female physicians of her time: “They have only tried to be men, and they have succeeded only in being third-rate men.” Indeed, as the number of nursing students rose in the late nineteenth century, the number of female medical students began to decline. Woman had found her place in the health system. Just as the feminist movement had not opposed the rise of medical professionalism, it did not challenge nursing as an oppressive female role. In fact, feminists of the late nineteenth century were themselves beginning to celebrate the nursemother image of femininity. The American women’s movement had given up the struggle for full sexual equality to focus exclusively on the vote, and to get it, they were ready to adopt the most sexist tenets of Victorian ideology: women need the vote, they argued, not because they are human, but be-

cause they are mothers. “Woman is the mother of the race,” gushed Boston feminist Julia Ward Howe, “the guardian of its helpless infancy, its earliest teacher, its most zealous champion. Woman is also the homemaker, upon her devolve the details which bless and beautify family life.” And so on, in paeans too painful to quote. The women’s movement dropped its earlier emphasis on opening up the professions to women: Why forsake motherhood for the petty pursuits of males? And of course the impetus to attack professionalism itself as inherently sexist and elitist was long since dead. Instead, they turned to professionalizing women’s natural functions. Housework was glamorized in the new discipline of “domestic science.” Motherhood was held out as a vocation requiring much the same preparation and skill as nursing or teaching. So while some women were professionalizing women’s domestic roles, others were “domesticizing” professional roles, like nursing, teaching, and, later, social work. For the woman who chose to express her feminine drives outside of the home, these occupations were presented as simple extensions of women’s “natural” domestic role. Conversely the woman who remained at home was encouraged to see herself as a kind of nurse, teacher, and counselor practicing within the limits of the family. And so the middle-class feminists of the late 1800s dissolved away some of the harsher contradictions of sexism. THE DOCTOR NEEDS A NURSE Of course, the women’s

movement was not in a position to decide on the future of nursing anyway. Only the medical profession was. At first, male doctors were a little skeptical about the new Nightingale nurses—perhaps suspecting that this was just one more feminine attempt to infiltrate medicine. But they were soon won over by the nurses’ unflagging obedience. (Nightingale was a little obsessive on this point. When she arrived in the Crimea with her newly trained nurses, the doctors at first ignored them all. Nightingale refused to let her

women lift a finger to help the thousands of sick and wounded soldiers until the doctors gave an order. Impressed, the doctors finally relented and set the nurses to cleaning up the hospital.) To the beleaguered doctors of the nineteenth century, nursing was a godsend. Here at last was a kind of health worker who did not want to compete with the “regulars,” did not have a medical doctrine to push, and who seemed to have no other mission in life but to serve. While the average regular doctor was making nurses welcome, the new scientific practitioners of the early twentieth century were making them necessary. The new, post-Flexner physician, was even less likely than his predecessors to stand around and watch the progress of his “cures.” He diagnosed, he prescribed, he moved on. He could not waste his talents, or his expensive academic training in the tedious details of bedside care. For this he needed a patient, obedient helper, someone who was not above the most menial tasks—in short, a nurse. Healing, in its fullest sense, consists of both curing and caring, doctoring and nursing. The old lay healers of an earlier time had combined both functions, and were valued for both. (For example, midwives not only presided at the delivery, but lived in until the new mother was ready to resume care of her children.) But with the development of scientific medicine, and the modern medical profession, the two functions were split irrevocably. Curing became the exclusive province of the doctor; caring was relegated to the nurse. All credit for the patient’s recovery went to the doctor and his “quick fix,” for only the doctor participated in the mystique of science. The nurse’s activities, on the other hand, were barely distinguishable from those of a servant. She had no power, no magic, and no claim to the credit. Doctoring and nursing arose as complementary functions, and the society which defined nursing as feminine could readily see doctoring as intrinsically “masculine.” If the nurse was idealized woman, the doctor was idealized man—combining intellect and action, abstract theory and hard-headed prag-

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matism. The very qualities which fitted Woman for nursing barred her from doctoring, and vice versa. Her tenderness and innate spirituality were out of place in the harsh, linear world of science. His decisiveness and curiosity made him unfit for long hours of patient nurturing. These stereotypes have proved to be almost unbreakable. Today’s leaders of the American Nursing Association may insist that nursing is no longer a feminine vocation but a neuter “profession.” They may call for more male nurses to change the “image,” insist that nursing requires almost as much academic preparation as medicine, and so on. But the drive to “professionalize” nursing is, at best, a flight from the reality of sexism in the health system. At worst, it is sexist itself, deepening the division among women health workers and bolstering a hierarchy controlled by men.

 We have our own moment of history to work out, our own struggles. What can we learn from the past that will help us—in a women’s health movement—today? These are some of our conclusions: ➤ We have not been passive bystanders in the history

of medicine. The present system was born in and shaped by the competition between male and female healers. The medical profession in particular is not just another institution which happens to discriminate against us: It is a fortress designed and erected to exclude us. This means to us that the sexism of the health system is not incidental, not just the reflection of the sexism of society in general or the sexism of individual doctors. It is historically older than medical science itself; it is deep-rooted, institutional sexism. Our enemy is not just “men” or their individual male chauvinism. It is the whole class system which enabled male, upper-class healers to win out and which forced us into subservience. Institutional sexism is sustained by a class system which supports male power. ➤

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There is no historically consistent justification for the exclusion of women from healing roles. Witches were attacked for being pragmatic, empirical, and immoral. But in the nineteenth century the rhetoric reversed. Women became too unscientific, delicate, and sentimental. The stereotypes change to suit male convenience—we don’t—and there is nothing in our “innate feminine nature” to justify our present subservience.

➤

➤ Men maintain their power in the health system through their monopoly of scientific knowledge. We are mystified by science, taught to believe that it is hopelessly beyond our grasp. In our frustration, we are sometimes tempted to reject science, rather than to challenge the men who hoard it. But medical science could be a liberating force, giving us real control over own bodies and power in our lives as health workers. At this point in our history, every effort to take hold of and share medical knowledge is a critical part of our struggle—knowyour-body courses and literature, self-help projects, counseling, women’s free clinics. ➤ Professionalism in medicine is nothing more than the institutionalization of a male upper-class monopoly. We must never confuse professionalism with expertise. Expertise is something to work for and to share; professionalism is—by definition— elitist and exclusive, sexist, racist and classist. In the American past, women who sought formal medical training were too ready to accept the professionalism that went with it. They made their gains in status—but only on the backs of their less privileged sisters: midwives, nurses, and lay healers. Our goal today should never be to open up the exclusive medical profession to women, but to open up medicine to all women.

This means that we must begin to break down the distinctions and barriers between women health workers and women consumers. We should build shared concerns: consumers aware of women’s needs as workers, workers in touch with women’s needs as consumers. Women workers can play a leadership role in collective self-help

➤

and self-teaching projects, and in attacks on health institutions. But they need support and solidarity from a strong women’s consumer movement. Our oppression as women health workers today is inextricably linked to our oppression as women. Nursing, our predominate role in the health system, is simply a workplace extension of our roles as wife and mother. The nurse is socialized to believe that rebellion violates not only her “professionalism,” but her very femininity. This means that the male medical elite has a very special stake in the maintenance of sexism in the society at large: doctors are the bosses in an industry where the workers are primarily women. Sexism in the society at large insures that the female majority of the health workforce are “good” workers—docile and passive. Take away sexism and you take away one of the mainstays of the health hierarchy. ➤

What this means to us in practice is that in the health system there is no way to separate worker organizing from feminist organizing. To reach out to women health workers as workers is to reach out to them as women. NOTES 1. Thomas Szasz, The Manufacture of Madness (Syracuse, NY: Syracuse University Press, 1997). 2. Heinrich Kramer and Jacob Sprenger, Malleus Maleficarum [Hammer of Witches] (n.p.: 1487).

Out of Conflict Comes Strength and Healing: Women’s Health Movements HELEN I. MARIESKIND Adapted from Helen I. Marieskind, Women in the Health System: Patients, Providers, and Programs, St. Louis, Missouri: C. V. Mosby, 1980. Reprinted by permission.

Helen Marieskind, founding editor of the journal Women and Health, chose her surname to honor her mother, Marie. (Kind is the German word for “child.”) With similar devotion she honors the

names and the work of some superstar women healers in history. (Hey, girlfriend, how about that Hildegard of Bingen?!)

onflict and activism in women’s health care have a long history; ancient issues remain with us. In 3500 , Egyptian midwives, jatromaiai, proudly protected their rights to practice surgery and internal medicine, distinguishing themselves from the strictly obstetrical practice of the maiai. Greece had many skilled women physicians, but by the third century , their service as abortionists, the influence of Hippocrates, and the growth of the Pythagorean school combined to prohibit them from practice. Women “picketed the courthouse,” winning the right to practice and acquittal of their favorite, Agnodice, arrested for practicing gynecology as a man. The growth of Christianity led to a deepening conviction by men of the church that women should keep out of public and religious affairs, and major conflicts over women’s role in health care delivery and in the nature of health care began in earnest. Saint Augustine had written, “educated women should take care of the sick,” but by the Council of Nantes in 660 , women were termed “soulless brutes.” Thus began centuries of denying education to women and male dominance in medicine. Only a few women—usually the wealthy, nobility, or clerics—were educated. Many of these women turned to monastic life, becoming medical missionaries with their monasteries as centers of healing. For example, the English princess Walpurga (c. 710–77), always depicted with a flask of urine and bandages, treated the poor at the monastery she founded in Germany. Hildegard of Bingen (1098–1179), who is best known today for her enchanting music, entered monastic life at age eight. In 1147, at age fifty, Hildegard built a new convent near Bingen, on the Rhine. Hildegard wielded great power, corresponding with popes, emperors, and kings. Fiery and prophetic, she published her theories on the chemistry and

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circulation of blood, the causes of contagion and autointoxication, and the brain as the origin of nerve action. Obstetrician Trotula di Ruggiero of Salerno, Italy, is credited in the mid-1100s with the first description of the physical signs of syphilis and, prior to an understanding of sepsis, for advocating the use of protective pads to prevent fecal contamination during childbirth. Anna Comnena (1083–1148) served as physicianin-chief of an 11,000-bed hospital in Constantinople (Istanbul). Conflict increased over the next centuries between the learned role of medical men and the widespread denial of education to women. Conflict was reinforced by church decrees in the early 1100s, the development of universities in most of Europe as primarily male preserves, the growth of essentially all-male guilds, and efforts at licensure by the church and state. Women’s roles in health care were confined to nurses, midwives, herb gatherers, ecclesiastical and lay village healers, and occasionally empirics, who were lay women apprenticed to university-educated practitioners. Women (along with barber-surgeons) became providers of simple, direct care—treating wounds and infections and setting bones. This dichotomy between learned men and primary care–giving women laid the groundwork for a further division of labor in which women healers were essentially limited to nursing tasks while male practitioners commanded an elite, specialist role. Jacoba Félicie de Almania’s case illustrates the point. Brought to trial in Paris in 1322 for failing to comply with a 1220 licensure law, Jacoba was confronted not with a charge of incompetence but with witnesses and a detailed reading of her medical practices, showing her to be both practical and knowledgeable. She argued that the licensure law of 1220 was made for “idiots and ignorant persons” who knew nothing of the art of medicine and from which groups she was excluded because of her skill and expertise. Her eloquent pleas for the need for women to be treated by other women are recorded in the Charter of Paris, II:

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It is better and more honest that a wise and expert woman in this art visit sick women and inquire into the secret nature of their infirmity, than a man to whom it is not permitted to see, inquire of, or touch the hands, breasts, stomach, etc. of a woman; nay rather ought a man shun the secrets of women and their company and flee as far as he can. Some outstanding midwives and women physicians did survive this period. Important female physicians were still emerging from Italy at a time when England and France were persecuting them. Dorothea Bocchi was appointed professor of medicine and moral philosophy at Bologna in 1390 and taught there for 40 years. A contemporary, Costanza Calenda of Naples, won high honors for her lecturing in medicine. By the sixteenth century, exclusion of women from most European learning centers was firmly entrenched (Italy was a notable exception). Intense conflicts over women’s health raged during the witch-hunts of medieval Europe, when thousands of people were slaughtered. Most of the women were lay women healers or “old wives” who served as midwives. This is an important distinction, because while accusations of witchcraft were also at times leveled at more recognized midwives, some separate provisions were made for them to be licensed. In England in 1587, for example, Eleanor Preade was licensed to perform the functions of midwife, including baptism. Witchcraft trials had a lasting effect on women’s place as healers, as the direct, primary, and often intimate caregiving roles had become so fraught with danger, that few women risked practicing for fear of being accused. The poor lost their village healers, and the professional control by church and state became firmly entrenched. Increasing corruption in the monasteries was matched by decreased interest in the medical and charitable aspects of clerical life, while the exclusion of women from the universities continued to effectively bar the participation of even upper-class women from medical practice. Moreover, by li-

censing some midwives and not others, stratifications and divisions formed among women healers, preventing a unified protest. Again, there were exceptions. Outstanding French midwives practiced from the sixteenth to the nineteenth centuries. Louyse Bourgeois (1563– 1636) set rules for handling each of the varied fetal positions. Angèlique Marguerite le Boursier du Coudray (1712–89) invented a model of the female torso and was ordered by Louis XVI to travel throughout the provinces, giving free instruction to all “unenlightened midwives.” Yet even in France, England, and Germany, where the skills of all highly accomplished midwives were well-rewarded, their discoveries published, and their talents sought after by the noblest and humblest of citizens, conflict still surrounded their licensure and entry into universities. “The midwives of the Academy have no desire of me,” mocked Madame Boivin (1773– 1847), midwife, decorated by the French crown and awarded an honorary MD degree by Germany in 1827, upon being denied entry into the (male) French Academy of Medicine. By the end of the eighteenth century, conflicts over female practitioners, particularly midwives, were highly institutionalized throughout Europe. In France and Germany, although the status of some was diminished, the training programs organized led to an overall increase in competence and respect, resulting in the incorporation of the midwife into modern health care systems. Midwives in England, however, were not only excluded from using rapidly developing technologies such as forceps, but were hampered also by their lack of organization, intragroup competitiveness, their assignment to obstetrics only, and by a wealthy and well-organized onslaught from the male physicians backed by church, state, and licensure laws. The ceaseless struggles of midwives such as Mrs. Elizabeth Nihell, Mrs. Sarah Stone, and Mrs. Elizabeth Cellier are colorful reading. It was not until Rosalind Paget founded the Midwives Institute in 1881 that the midwife once more became an integral part of the English health care system.

In the American colonies several midwives served their communities with great skill. The first midwife of record, Brigett Fuller, as her name is spelled on the land ownership register, reached the Plymouth colony in 1623 on the Anne and joined her physician husband Samuel, a Mayflower passenger. There was also Anne Hutchinson, a midwife, an organizer of women, and a religious dissident who cofounded a settlement in Rhode Island. We know of a Mrs. Wiat from her epitaph of 1705: “She assisted at ye births of one thousand, one hundred and odd children.” The diary of Martha Ballard, midwife, converted to a contemporary book and film, aptly captures the poignant hardships and the joys of the midwife’s role in colonial America. In the United States, too, the midwife gradually lost her status, as did practicing female physicians— generally for the same reasons as in England. Women physicians, such as Dr. Mary Lavinder (1776–1845), who set up a pediatric and midwifery practice in Savannah, Georgia, in 1814, and Dr. Sarah E. Adams (1779–1846), also a practitioner in Georgia, were highly popular and successful even if not given equal status. Similarly, Harriet K. Hunt (1805–75) gained a large following in her Boston practice, even though she had no degree. Oliver Wendell Holmes supported her application to Harvard Medical School, and the faculty could find nothing in the statutes to deny her admission. Nevertheless, Hunt was forced to withdraw her application when the students resolved: “That we object to having the company of any female forced upon us, who is disposed to unsex herself, and to sacrifice her modesty by appearing with men in the lecture room.” The greatest conflicts around women’s health care in the United States arose during the popular health movement of the 1830s and 1840s, continuing well into the twentieth century. A current of liberal, democratic thinking hostile to professionalism, fostered the growth of the popular health movement, aided by lax or nonexistent licensing laws, a broad recognition of home cures and synergy between body and mind, and by a generally

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held belief that anyone who demonstrated healing skills should be permitted to practice medicine. Feminists, women practitioners such as Harriet K. Hunt, and working-class radicals joined together in the popular health movement to reject the perceived arrogance and incompetence of most doctors of the day. During and following the mid-nineteenth century, women were widely regarded as inherently sickly, as documented by Ben Barker-Benfield in Horrors of the Half-Known Life. To help protect themselves, women at Ladies’ Physiological Reform Societies, an outgrowth of the popular health movement, lectured on sensible—yet radical—ideas such as personal hygiene and frequent bathing, preventive care, elementary anatomy, loose-fitting female clothing (whalebone corsets worn by women of fashion disastrously cramped their internal organs), temperance, the importance of a healthy diet including whole-grain cereals, sex, and birth control. Birth control, and woman’s right to it, continued to be highly controversial even up to the repeal of the last of the Comstock Laws in 1965 in Connecticut. Female sectarian medical colleges established by branches of the popular health movement offered courses to women to improve both their own health and that of their families, while women graduates frequently taught through the societies. Lydia Folger Fowler (1822–79) was one such teacher; in 1851 she was appointed professor of midwifery at the Rochester Eclectic Medical College, becoming the first woman to hold a professorship in a legally authorized medical school in the United States. These and other topics, including abortion rights, the doctor-patient relationship, and overuse of drugs and surgical intervention, together with many of the historical issues of women’s health care such as licensure, sparked the women’s health movement of the 1960s and remain central to women’s health issues today. We are still struggling over questions of licensure, of whether technological intervention of specialists is superior to the more natural healing methods of general practitioners

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and midwives, and while there are now almost as many women as men in medical schools, certain specialties are still dominated by men. Given today’s advanced technology, the complexities have changed, but the fundamental conflicts surrounding women’s health care—who determines and controls the right to practice and in what manner—remain the same. This sameness does not invalidate today’s issues in any way, but shows us there are lessons to be learned from past struggles.

Medicine and Morality in the Nineteenth Century KRISTIN LUKER Kristen Luker, excerpt from Abortion and the Politics of Motherhood, Berkeley, California: University of California Press, 1984. Reprinted by permission.

Kristin Luker, sociologist at the University of California, San Diego, demonstrates how—beginning in 1859—the American Medical Association launched a successful campaign to ban induced abortions, not for the sake of their patients’ health (to the contrary: more women’s lives were lost) but to publicize themselves and call attention to their own “moral stature” and “technical expertise.”

urprising as it may seem, the view that abortion is murder is a relatively recent belief in American history. To be sure, there has always been a school of thought, extending back at least to the Pythagoreans of ancient Greece, that holds that abortion is wrong because the embryo is the moral equivalent of the child it will become. Equally ancient, however, is the belief articulated by the Stoics: that although embryos have some of the rights of already-born children (and these rights may increase over the course of the pregnancy), embryos are of a different moral order, and thus to end their existence by an abortion is not tantamount to murder. . . . In the Roman Empire, abortion was so frequent and widespread that it was remarked upon by a number of authors. Ovid, Juvenal, and Seneca all

noted the existence of abortion, and the natural historian Pliny listed prescriptions for drugs that would accomplish it. Legal regulation of abortion in the Roman Empire, however, was virtually nonexistent. Roman law explicitly held that the “child in the belly of its mother” was not a person, and hence abortion was not murder. After the beginning of the Christina era, such legal regulation of abortion as existed in the Roman Empire was designed primarily to protect the rights of fathers rather than the rights of embryos. . . .

     --  At the opening of the nineteenth century, no statute laws governed abortion in America. What minimal legal regulation existed was inherited from English common law tradition that abortion undertaken before quickening was at worst a misdemeanor. Quickening, as that term was understood in the nineteenth century, was the period in pregnancy when a woman felt fetal movement; though it varies from woman to woman (and even from pregnancy to pregnancy in the same woman), it generally occurs between the fourth and the sixth month of pregnancy. Consequently in nineteenth-century America, as in medieval Europe, first-trimester abortions, and a goodly number of second-trimester abortions as well, faced little legal regulation. Practically speaking, the difficulty of determining when conception had occurred, combined with the fact that the only person who could reliably tell when the pregnancy had “quickened” was the pregnant woman herself, meant that even this minimal regulation was probably infrequent. In 1809, when the Massachusetts State Supreme Court dismissed an indictment for abortion because the prosecution had not reliably proved that the woman was “quick with child,” it was simply reiterating traditional common law standards. In contrast, by 1900 every state in the Union had passed a law forbidding the use of drugs or instruments to procure abortion at any stage of

pregnancy, “unless the same be necessary to save the woman’s life.” Not only were those who performed an abortion liable for a felony (usually manslaughter or second-degree homicide), but in many states, the aborted woman herself faced the possibility of criminal prosecution, still another departure from the tolerant common law tradition in existence at the beginning of the century. Many cultural themes and social struggles lie behind the transition from an abortion climate that was remarkably open and unrestricted to one that restricted abortions (at least in principle) to those necessary to save the life of the mother. The second half of the nineteenth century, when the bulk of American abortion laws were written, saw profound changes in the social order, and these provided the foundation for dramatic changes in the status of abortion. Between 1850 and 1900, for example, the population changed from one that was primarily rural and agricultural to one that was urban and industrial, and the birth rates fell accordingly, declining from an estimated average completed fertility for whites of 7.04 births per woman in 1800 to an average of 3.56 births in 1900. The “great wave” of American immigration occurred in this period, as did the first feminist movement. The intricate relationships between social roles, moral values, and medical technologies that were associated with changing patterns of fertility simultaneously became both the cause and the product of demographic strains—strains between rural and urban dwellers; between native-born “Yankees” and immigrants; between the masses and the elites; and possibly between men and women. But within this complex background against which the first American debate on abortion emerged, we can trace a more direct social struggle. The most visible interest group agitating for more restrictive abortion laws was composed of elite or “regular” physicians, who actively petitioned state legislatures to pass anti-abortion laws and undertook through popular writings a campaign to

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change public opinion on abortion. The efforts of these physicians were probably the single most important influence in bringing about nineteenthcentury anti-abortion laws. (Ironically, a century later it would be physicians who would play a central role in overturning these same laws.) Even more important is the fact that nineteenth-century physicians opposed abortion as part of an effort to achieve other political and social goals, and this led them to frame their opposition to abortion in particular ways.

     Modern observers accustomed to thinking of the medical profession as prestigious, technically effective, and highly paid are sometimes shocked to learn that it was none of those things in the nineteenth century. On the contrary, much of its history during that century was an uphill struggle to attain just those attributes. Whereas European physicians entered the modern era with at least the legacy of well-defined guild structures—structures that took responsibility for teaching, maintained the right to determine who could practice, and exercised some control over the conduct and craft of the profession—American physicians did not. Because of its history as a colony, the United States attracted few guild-trained physicians, and consequently, a formal guild structure never developed. Healing in this country started out primarily as a domestic rather than a professional skill (women and slaves often developed considerable local reputations as healers), and therefore anyone who claimed medical talent could practice—and for the most part could practice outside of any institutional controls of the sort that existed in Europe. From the earliest days of the medical profession in this country, therefore, physicians wanted effective licensing laws that would do for them what the guild structures had done for their European colleagues, namely, restrict the competition.

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For the first third of the century, physicians had depended on a model of illness that called upon the use of drastic medical treatments such as bleeding or the administration of harsh laxatives and emetics. By the 1850s, a new group of physicians (including such luminaries as Oliver Wendell Holmes) rejected the use of this “heroic armamentarium” and earned for themselves the sobriquet of “therapeutic nihilists” inasmuch as they seemed to argue that anything a physician could do was probably ineffective and might be dangerous as well. Two other developments in the course of the century kept the social and professional status of medicine low. First, as the effectiveness of “heroic” medicine was called into question by some physicians themselves, there was a proliferation of healers who advocated new models of treatment. Thomsonians, botanics, and homeopaths among others all developed “sects” of healing and claimed the title of doctor for themselves. These nineteenth-century sectarians flourished, perhaps in part because they intended to support relatively mild forms of treatment (baths, natural diets) instead of the “heroic” measures used by many doctors. Thus, regular physicians (those who had some semblance of formal training and who subscribed to the dominant medical model) found themselves in increasing competition with the sectarians, who they considered quacks. . . .

  -  With respect to abortion, as with respect to physicians, modern-day stereotypes about the nineteenth century can easily lead us astray. Contrary to our assumptions about “Victorian morality,” the available evidence suggests that abortions were frequent. To be sure, some of these abortions may have been disguised (or rationalized) by those who sought them. Early in the century, a dominant therapeutic model saw the human body as an “intake-outflow” system and disease as the result of some disturbance in the regular production of secretions. Prominent

among medical concerns, therefore, was “blocked” or “obstructed” menstruation, and the nineteenthcentury pharmacopoeia contained numerous emmenagogues designed to “bring down the courses,” that is, to reestablish menstruation. However, since the primary cause of “menstrual obstruction” in a healthy and sexually active woman was probably pregnancy, at least some of these emmenagogues must have been used with the intent to cause an abortion. Especially in the absence of accurate pregnancy tests, these drugs could be used in good faith by physicians and women alike, but the frequent warnings that these same drugs should not be used by “married ladies” because they would cause miscarriage made their alternative uses quite clear. . . .

   In the second half of the nineteenth century, abortion began to emerge as a social problem: newspapers began to run accounts of women who had died from “criminal abortions,” although whether this fact reflects more abortions, more lethal abortions, or simply more awareness is not clear. Most prominently, physicians became involved, arguing that abortion was both morally wrong and medically dangerous. The membership of the American Medical Association (AMA), founded in 1847 to upgrade and protect the interests of the profession, was deeply divided on many issues. But by 1859, it was able to pass a resolution condemning induced abortion and urging state legislatures to pass laws forbidding it; in 1860, Henry Miller, the president-elect of the association, devoted much of his presidential address to attacking abortion; and in 1864, the AMA established a prize to be awarded to the best antiabortion book written for the lay public. Slowly, physicians responded to the AMA’s call and began to lobby in state legislatures for laws forbidding abortion. Why should nineteenth-century physicians have become so involved with the question of

abortion? The physicians themselves gave two related explanations for their activities, and these explanations have been taken at face value ever since. First, they argued, they were compelled to address the abortion questions because American women were committing a moral crime based on ignorance about the proper value of embryonic life. According to these physicians, women sought abortions because the doctrine of quickening led them to believe that the embryo was not alive, and therefore aborting it was perfectly proper. Second, they argued, they were obliged to act in order to save women from their own ignorance because only physicians were in possession of new scientific evidence which demonstrated beyond a shadow of doubt that the embryo was a child from conception onward. The physicians were probably right in their belief that American women did not consider abortion—particularly early abortion—to be morally wrong. But the core of the physicians’ claim— the assertions that women practiced abortion because they were ignorant of the biological facts of pregnancy and that physicians were opposed to it because they were in possession of new scientific evidence—had no solid basis in fact. . . .

   Thus, the question remains: Why, in the middle of the nineteenth century, did some physicians become active anti-abortionists? James Mohr, in a pioneering work on this topic, argues that the proliferation of healers in the nineteenth century created a competition for status and clients. The “regular” physicians, who tended to be both wealthier and better educated than members of other medical sects, therefore sought to distinguish themselves both scientifically and socially from competing practitioners. Mohr suggests that there were several more practical reasons why regular physicians should have opposed abortion. On the one hand, outlawing abortion would remove a lucrative source of

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income from competitors they called “quacks” and perhaps remove the temptation from the path of the “regulars” as well. In addition, the “regulars” were predominantly white, upper-income, and native-born; as such, they belonged to precisely the same group that was thought to harbor the primary users of abortion. As a result, they were likely to be concerned both about the depopulation of their group in the face of mounting immigration (and the higher fertility of immigrants) and about “betrayal” by their own women (because abortion required less male control and approval than the other available forms of birth control). More broadly, Mohr argues that nineteenthcentury physicians had a firm ideological belief that abortion was in fact murder. He asserts that they tended to place absolute value on human life and that having established to their own satisfaction that abortion represented the loss of human life, abortion became included in this more general value. The historian Carl Degler has made much the same argument: “Seen against the broad canvas of humanitarian thought and practice in Western society from the seventeenth to the twentieth century, the expansion of the definition of life to include the whole career of the fetus rather than only the months after quickening is quite consistent. It is in line with a number of movements to reduce cruelty and to expand the concept of sanctity of life.” . . . By the middle of the nineteenth century, American physicians had few if any of the formal attributes of a profession. The predominance of proprietary medical schools combined with the virtual absence of any form of licensing meant that the regulars could control neither entry into the profession nor the performance of those who claimed healing capacities. With the possible exceptions of the thermometer, the stethoscope, and the forceps, the technological tools of modern medicine were yet to come; and lacking the means of professional control, regular physicians were hard put to keep even those simple instruments out of the hands of the competition. Because they

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could offer no direct, easily observable, and dramatic proof of their superiority, regular physicians were forced to make an indirect, symbolic claim about their status. By becoming visible activists on an issue such as abortion, they could claim both moral stature (as a high-minded, self-regulating group of professionals) and technical expertise (derived from their superior training). Therefore the physicians’ choice of abortion as the focus of their moral crusade was carefully calculated. Abortion, and only abortion, could enable them to make symbolic claims about their status. Unlike the other medico-moral issues of the time— alcoholism, slavery, venereal disease, and prostitution —only abortion gave physicians the opportunity to claim to be saving human lives. Given the primitive nature of medical practice, persuading the public that embryos were human lives and then persuading the state legislatures to protect these lives by outlawing abortion may have been one of the few life-saving projects actually available to physicians. Physicians, therefore, have to exaggerate the differences between themselves and the lay public. Anti-abortion physicians had to claim that women place no value on embryonic life whereas they themselves ranked the embryo as a full human life, namely, as a baby. But these two positions, when combined, created an unresolvable paradox for physicians, a paradox that would haunt the abortion debate until the present day.

Ain’t I a Woman? SOJOURNER TRUTH Sojourner Truth, “Ain’t I a Woman?,” speech delivered 1851. Women’s Convention, Akron, Ohio.

Sojourner Truth (1797–1883) was born into slavery in New York State. She won her freedom in 1827, when that state emancipated its slaves. After working in New York City as a domestic for some years, she felt called by God to testify to the sins against her

people. Dropping her slave name, Isabella, she took the symbolic name of Sojourner Truth. She spoke at camp meetings, private homes, wherever she could gather an audience. By midcentury she was well-known in antislavery circles and a frequent speaker at abolitionist gatherings. Sojourner Truth consistently and actively identified herself with the cause of women’s rights. She was the only black woman present at the First National Woman’s Rights Convention in Worcester, Massachusetts, in 1850. The following year Sojourner Truth spoke at a women’s convention at Akron, Ohio, presided over by Frances D. Gage. Since Truth could neither read nor write, all her words have come down through history interpreted by other people, usually white women, all of whom had their own agendas. As Nell Irvine Painter points out in her 1996 book, Sojourner Truth: A Life, a Symbol, “Truth depended upon disparate amanuenses for the preservation of her identity. They represented her according to their own lights, often in dialect of their own invention.” The Akron speech was written down by Gage twelve years after it was spoken as a response to an article in The Atlantic Monthly by Harriet Beecher Stowe. Where Stowe’s version of Sojourner Truth emphasizes her religion, Gage emphasizes or invents anger. Specifically, the phrase “ar’nt I a woman?,” sometimes written in dialect as “ain’t I a woman?,” was Gage’s invention.

planted, and gathered into barns, and no man could head me! And ain’t I a women? I could work as much and eat as much as a man—when I could get it—and bear the lash as well! And ain’t I a woman? I have borne thirteen children, and seen them most all sold off to slavery, and when I cried out with my mother’s grief, none but Jesus heard me! And ain’t I a woman? Then they talk about this thing in the head; what’s this they call it? [Intellect, someone whispers.] That’s it, honey. What’s that got to do with women’s rights or Negro’s rights? If my cup won’t hold but a pint, and yours holds a quart, wouldn’t you be mean not to let me have my little half-measure full? Then that little man in black there, he says women can’t have as much rights as man, ’cause Christ wasn’t a woman! Where did your Christ come from? Where did you Christ come from? From God and a woman! Man had nothing to do with Him. If the first woman God ever made was strong enough to turn the world upside down all alone, these women together ought to be able to turn it back, and get it right side up again! And now they is asking to do it, the men better let them. Obliged to you for hearing me, and now old Sojourner ain’t got nothing more to say.

Elizabeth Cady Stanton, excerpt from Alice S. Rossi, ed., The Feminist Papers: From Adams to de Beauvoir, New York: Bantam Books, 1973, pp. 399–401. Originally published in Elizabeth Cady Stanton: As Revealed in Her Letters, Diary, and Reminiscences, New York: Harper & Bros., 1922. Reprinted by permission.

ell, children, where there is so much racket there must be something out of kilter. I think that ’twixt the Negroes of the South and the women at the North, all talking about rights, the white men will be in a fix pretty soon. But what’s all this here talking about? That man over there says that women need to be helped into carriages, and lifted over ditches, and to have the best place everywhere. Nobody ever helps me into carriages, or over mud puddles, or gives me any best place! And ain’t I a woman? Look at me! Look at my arm! I have ploughed and

On Motherhood ELIZABETH CADY STANTON

Her public cause was “votes for women,” but her private mission and personal creed was “self-reliance,” particularly in matters of health. Elizabeth Cady Stanton—the boldest and most brilliant of nineteenth-century American feminists—was born on November 12, 1815, in upstate New York. The family

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was prosperous; her father was a judge and her mother was of aristocratic lineage. Of the Cadys’ eleven children, only five daughters survived. As a girl Elizabeth studied homeopathy with her brother-in-law, Dr. Edward Bayard. In 1840 she married Henry Stanton—abolitionist, co-founder of Oberlin College, and a follower of Sylvester Graham, a charismatic lecturer, father of the Graham cracker, and, the record suggests, the Gary Null of his era, known for his passionate advocacy of daily excercise combined with a balanced, largely vegetarian diet. A neighbor, Amelia Bloomer, once wrote on the envelope of a letter she forwarded to Elizabeth, “People have nothing to talk about when you are gone!” That was because Elizabeth usually acted on her beliefs, however unpopular. When her hometown refused to open its tax-supported calisthenics classes to girls, she converted her barn into a gym and subversively offered instruction. Armed with her homeopathic manual and her herbs, she “doctored” her own and her neighbors’ children through malaria, whooping cough, mumps, and broken limbs, and even helped deliver some of them. For more than fifty years, there seemed to be no impediment to women’s full equality that Elizabeth did not notice and attempt to rout: besides suffrage, she campaigned for birth control, property rights for wives, custody rights for mothers, equal wages, cooperative nurseries, coeducation, and “deliverance from the tyranny of self-styled medical, religious, and legal authorities.” In a famous speech delivered in Rochester, New York, on August 2, 1948, she declared: Woman herself must do this work—for woman alone can understand the height, and the depth, the length, and the breadth of her own degradation and woe. Man cannot speak for us—because he has been educated to believe that we differ from him so materially that he cannot judge of our thoughts, feelings, and opinions on his own. Through it all Elizabeth was a doting, hands-on mother of five sons and two daughters, born between 1842, when she was twenty-six, and 1859, when she

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was forty-three. It was said that if she wasn’t already pregnant or nursing, Elizabeth conceived each time that Henry (a traveling man) came home. She so enjoyed the company of her children (permissively raised, energetic and uppity like their mom) that she moved her writing desk into their nursery. The acid test of her maternal “self-reliance” occurred when her eldest, Daniel (called “Neil”), was born with a dislocated shoulder. The doctors she consulted set it in restrictive bandages, which made the condition worse. “With my usual conceit,” she told Henry, “I removed the bandages and turned surgeon myself.” Here is the story in Stanton’s own words, compiled by two of her younger children, Theodore Stanton and Harriot Stanton Blatch, in their old age, and published in 1922, eighty years after their mother first drew her line in the sand to protect and preserve their brother Neil.

esides the obstinacy of the nurse, I had the ignorance of physicians to contend with. When the child was four days old we discovered that the collarbone was bent. The physician, wishing to get a pressure on the shoulder, braced the bandage round the wrist. “Leave that,” he said, “ten days, and then it will be all right.” Soon after he left I noticed that the child’s hand was blue, showing that the circulation was impeded. “That will never do,” said I. “Nurse, take it off.” “No, indeed,” she answered, “I shall never interfere with the doctor.” So I took it off myself, and sent for another doctor, who was said to know more of surgery. He expressed great surprise that the first physician called should have put on so severe a bandage. “That,” said he, “would do for a grown man, but ten days of it on a child would make him a cripple.” However, he did nearly the same thing, only fastening it round the hand instead of the wrist. I soon saw that the ends of the fingers were all purple, and that to leave that on ten days would be as dangerous as the first. So I took it off. “What a woman!” exclaimed the nurse. “What do you propose to do?” “Think out something better myself; so brace me up with some pillows

and give the baby to me.” She looked at me aghast. “Now,” I said, talking partly to myself and partly to her, “what we want is a little pressure on that bone; that is what both of those men aimed at. How can we get it without involving the arm, is the question?” “I am sure I don’t know,” said she, rubbing her hands and taking two or three brisk turns around the room. “Well, bring me three strips of linen, four double.” I then folded one, wet in arnica and water, and laid it on the collarbone, put two other bands, like a pair of suspenders over the shoulder, crossing them both in front and behind, pinning the ends to the diaper, which gave the needed pressure without impeding the circulation anywhere. As I finished she gave me a look of budding confidence, and seemed satisfied that all was well. Several times, night and day, we wet the compress and readjusted the bands, until all appearance of inflammation had subsided. At the end of ten days the two sons of Aesculapius appeared and made their examination, and said all was right, whereupon I told them how badly their bandages worked, and what I had done myself. They smiled at each other, and one said, “Well, after all, a mother’s instinct is better than a man’s reason.” “Thank you, gentlemen, there was no instinct about it. I did some hard thinking before I saw how I could get pressure on the shoulder without impeding the circulation, as you did.” Thus, in the supreme moment of a young mother’s life, when I needed tender care and support, the whole responsibility of my child’s supervision fell upon me; but though uncertain at every step of my own knowledge, I learned another lesson in self-reliance. I trusted neither men nor books absolutely after this, either in regard to the heavens or the earth beneath, but continued to use my “mother’s instinct,” if “reason” is too dignified a term to apply to a woman’s thoughts. My advice to every mother is, above all other arts and sciences, study first what relates to babyhood, as there is no department of human action in which there is such lamentable ignorance.

ovember 12, 1895, Elizabeth Cady Stanton’s eightieth birthday, found her enthroned on the stage of the Metropolitan Opera House, where 6,000 people had gathered to celebrate. Behind her, on the stage, red carnations spelled out her name in a field of white chrysanthemums, while roses banked her red velvet chair. Following three hours of ovations, tributes (“America’s Grand Old Woman,” “Queen Mother of American Suffragists”), and gifts—including an onyx-and-silver ballot box presented by a delegation of Mormon women from the Utah Territory—Stanton rose and gently reminded her admirers: “I am well aware that all these public demonstrations are not so much tributes to me as an individual as to the great idea I represent—the enfranchisement of women.” Two weeks later, she was in big trouble. Her book, The Woman’s Bible, was published, and quickly became a best seller, but, according to her biographer Elisabeth Griffith, she was branded as a heretic by a stunned public. The Woman’s Bible argued that “the chief obstacle in the way of woman’s elevation today is the degrading position assigned her in the religion of all countries—an afterthought in creation, the origin of sin, cursed by God, marriage for her a condition of servitude, maternity a degradation, unfit to minister at the altar and in some churches even to sing in the choir.” Elizabeth, whose mealtime grace was addressed to “Mother and Father God,” proclaimed her belief in an androgynous creator and declared that the story of the expulsion from Eden was a myth. Far from being cursed, woman had been the originator and ruler of Amazonian societies before man seized control and subjugated her. Humiliated by Elizabeth’s “blasphemy,” the younger, more “practical” leadership in the suffrage

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organizations shunned her, convinced that she, their founding mother, had recklessly jeopardized their cause. “They refused to read my letters and resolutions to the conventions; they have denounced The Woman’s Bible unsparingly,” Elizabeth wrote. Susan B. Anthony, Elizabeth’s protégé and junior collaborator, was now put forward as the symbol and standard bearer of suffrage. Susan’s name, alone, would attach to the 1920 Constitutional amendment; her face, alone, to the commemorative coin and stamp. Elizabeth died in 1902, eighteen years before women got the vote, fifty-four years after she first demanded it, fifty-one years after she met Susan and recruited her to the cause. In the spirit of androgyny, Elizabeth’s funeral service in her New York City apartment was conducted by a man assisted by the Reverend Antoinette Brown Blackwell. Her graveside service was conducted by a woman alone, the Reverend Phebe Hanaford. Elizabeth was quite content in her old age despite (or perhaps because of) the controversy that her Woman’s Bible inspired. As her biographer Lois Banner has written: “Politics was not really congenial to her. Independent by nature . . . the political mode of moderation, compromise, and slow progress did not fit her. Rather she preferred to shock her colleagues, to stir them out of complacency, to arouse their passions through introducing issues they had not considered. . . . Since the founding of the women’s movement, she had seen her role as that of its radical conscience. . . . She had introduced suffrage in 1848 when the proposal had been new and shocking, [but now it was] accepted by all feminists and actually in force in the territories.” The following selections were written to stir readers out of complacency, to introduce issues they had not considered, and overall, to heighten our consciousness of woman’s role in history.

Sylvia Bernstein Seaman (1900–95) KAREN BEKKER Karen Bekker, excerpt from Paula Hyman and Deborah Dash Moore, eds., Jewish Women in America, vol. 2, New York: Routledge, 1997. Reprinted by permission.

Sharon Batt, founder of Breast Cancer Action Montreal and author of Patient No More: The Politics of Breast Cancer, remarked in 1999, “Many of the women who spoke out at the beginning . . . had been involved in activist politics before their diagnosis. But [other] women who wrote and spoke and lobbied had no such analysis. They just had breast cancer, and were more vulnerable to cooptation by vested interests.” In that regard, I close this section in homage to my non-co-optable mother-in-law, Sylvia Seaman, who was born in 1900, played hooky from high school to participate in suffrage demonstrations, and helped introduce breast cancer activism in 1965 with the publication of her book, Always a Woman, about the mastectomy she’d undergone a decade earlier. It was the first such book by a patient prying open the “closet door,” as if in preparation for the transformative 1970s titles, Why Me? by Rose Kushner and First You Cry by Betty Rollin. Sylvia’s book also publicized Reach to Recovery, the first and initially the most radical of breast cancer self-help organizations, which was acquired by the American Cancer Society in 1969 and then tamed down—if not co-opted. She died in 1995 when the breast cancer—diagnosed forty years before—caught up with her as she was preparing her speech for the Diamond Jubilee of the Nineteenth Amendment. I like to remind my children that their paternal grandmother may well have been the last living link between the politics of Elizabeth Cady Stanton, and the activist health feminists of today.

’m still capable of marching. I marched sixty years ago. I just hope my granddaughter doesn’t have to march into the next century.” So said

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Sylvia Bernstein Seaman to a New York Times reporter on the occasion of the tenth anniversary of the 1970 Women’s Strike for Equality and the coinciding sixtieth anniversary of woman suffrage (Fig. 1). During her long life, she was not only a witness to but a catalyst for the dramatic changes in women’s roles and status over the course of this century. Sylvia Bernstein was born on November 8, 1900, to Nathan Bernstein and Fanny (Bleat) Bernstein. She had one sibling, a younger brother, Steven. She was active in the women’s movement from a very young age and first marched for suffrage in 1915. While a student at Cornell University, she marched in the celebratory parades of 1920 when the Nineteenth Amendment was passed and was arrested for publicly wearing riding britches. This was, however, only the beginning of her career as a feminist. After spending several years teaching high school English in New York City, and marrying chemist William Seaman, in 1925, she began writing professionally. Her first books were novels written in collaboration with her college roommate Frances Schwartz and published under the pen name Francis Sylvin. In 1965, she published Always a Woman: What Every Woman Should Know about Breast Cancer, a book based on her own experience of a mastectomy. This was the first book written about breast cancer by someone outside the medical profession. The topic, about which Seaman also wrote magazine and newspaper articles, was rarely discussed publicly in the early 1960s. In a 1980 interview, Seaman recalled, “It was considered daring at the time, but it changed attitudes, I think. . . . As for me, I got so much fan mail on that book, you’d have thought I was a movie star.” How to Be a Jewish Grandmother (1979) is a humorous book of advice and anecdotes. Any topic was fair game for Seaman: vasectomies, daughters-in-law, even her own drinking habits. Besides the discussion of what it meant to be Jewish, a woman, and a grandmother, the book was an indication of the changes American culture

Figure 1: From marching for woman suffrage in 1915 to her groundbreaking book on breast cancer fifty years later to How to Be a Jewish Grandmother, Sylvia Seaman candidly and courageously explored a wide range of feminist issues. She is shown here in August 1980 leading a demonstration in celebration of sixty years of women’s suffrage. [Carol Halebian]

had undergone in this century. How to Be a Jewish Grandmother is a record of the shifting social order of the 1970s, presented from the point of view of one who had herself rebelled against the norms of an earlier generation, but who may have been just a little bit bewildered by the transformations she was witnessing. Seaman was not the only political activist in her family. Her son, Gideon Seaman, and daughter-in-law Barbara Seaman, coauthored Women and the Crisis in Sex Hormones in 1977; Barbara was also a co-founder of the National Women’s Health Network. It was she who had encouraged Sylvia to write Always a Woman.

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It was breast cancer that many years later caused Sylvia Bernstein Seaman’s death, on January 8, 1995.

Fanny Burney’s Letter to Her Sister, 1812, describing her mastectomy in September of 1811 FANNY BURNEY Fanny Burney, excerpt from Selected Letters and Journals, London: Oxford University Press, 1986. Public Domain.

. Dubois acted as Commander in Chief. Dr. Larry kept out of sight; M. Dubois ordered a Bed stead into the middle of the room. Astonished, I turned to Dr. Larry, who had promised that an Arm Chair would suffice; but he hung his head, & would not look at me. Two old mattresses M. Dubois then demanded, & an old Sheet. I now began to tremble violently, more with distaste & horror of the preparations even than of the pain. These arranged to his liking, he desired me to mount the Bed stead. I stood suspended, for a moment, whether I should not abruptly escape—I looked at the door, the windows—I felt desperate—but it was only for a moment, my reason then took the command, & my fears & feelings struggled vainly against it. I called to my maid—she was crying, & the two Nurses stood, transfixed, at the door. Let those women all go! cried M. Dubois. This order recovered me my Voice—No, I cried, let them stay! qu’elles restent! (“Let them remain!”) This occasioned a little dispute, that re-animated me—the maid, however, & one of the nurses ran off—I charged the other to approach, & she obeyed. M. Dubois now tried to issue his commands en militaire, but I resisted all that were resistible—I was compelled, however, to submit to taking off my long robe de Chambre, which I had meant to retain—Ah, then, how did I think of my Sisters!—not one, at so dreadful an instant, at hand, to protect—adjust—guard me—I regretted that I had refused Mile de Maisonneuve—Mile

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Chastel—no one upon whom I could rely—my departed Angel!—how did I think of her!—how did I long—long for my Esther—my Charlotte! — My distress was, I suppose, apparent, though not my Wishes, for M. Dubois himself now softened, & spoke soothingly. Can You, I cried, feel for an operation that, to You, must seem so trivial?—Trivial? he repeated—taking up a bit of paper, which he tore, unconsciously, into a million of pieces, Oui— c’est peu de chose—mais (“Yes, it is a little thing, but . . .”)—he stammered, & could not go on. No one else attempted to speak, but I was softened myself, when I saw even M. Dubois grow agitated, while Dr. Larry kept always aloof, yet a glance showed me he was pale as ashes. I knew not, positively, then, the immediate danger, but every thing convinced me danger was hovering about me, & that this experiment could alone save me from its laws. I mounted, therefore, unbidden, the Bed stead—& M. Dubois placed me upon the mattress, & spread a cambric handkerchief upon my face. It was transparent, however, & I saw, through it, that the Bedstead was instantly surrounded by the seven men & my nurse. I refused to be held; but when, Bright through the cambric, I saw the glitter of polished Steel—I closed my Eyes. I would not trust to convulsive fear the sight of the terrible incision. A silence the most profound ensued, which lasted for some minutes, during which, I imagine, they took their orders by signs, & made their examination—Oh what a horrible suspension!—I did not breathe—& M. Dubois tried vainly to find any pulse. This pause, at length, was broken by Dr. Larry, who, in a voice of solemn melancholy, said Qui me tiendra ce sein? (“Who will hold the center?”)—No one answered; at least not verbally; but this aroused me from my passively submissive state, for I feared they imagined the whole breast infected—feared it too justly—for, again through the Cambric, I saw the hand of M. Dubois held up, while his forefinger first described a straight line from top to bottom of the breast, secondly a Cross, & thirdly a Circle; intimating that the WHOLE was to be taken off.

Excited by this idea, I started up, threw off my veil, &, in answer to the demand Qui me tiendra ce sein? cried C'est moi, Monsieur! & I held my hand under it, & explained the nature of my sufferings, which all sprang from one point, though they darted into every part. I was heard attentively, but in utter silence, & M. Dubois then replaced me as before, &, as before, spread my veil over my face. How vain, alas, my representation! immediately again I saw the fatal finger describe the Cross—& the circle—Hopeless, then, desperate, & self-given up, I closed once more my Eyes, relinquishing all watching, all resistance, all interference, & sadly resolute to be wholly resigned. My dearest Esther,—& all my dears to whom she communicates this doleful ditty, will rejoice to hear that this resolution once taken, was firmly adhered to, in defiance of a terror that surpasses all description, & the most torturing pain. Yet— when the dreadful steel was plunged into the breast—cutting through veins—arteries—flesh— nerves—I needed no injunctions not to restrain my cries. I began a scream that lasted unremittingly during the whole time of the incision—& I almost marvel that it rings not in my Ears still! so excruciating was the agony. When the wound was made, & the instrument was withdrawn, the pain seemed undiminished, for the air that suddenly rushed into those delicate parts felt like a mass of minute but sharp & forked poniards, that were tearing the edges of the wound—but when again I felt the instrument—describing a curve—cutting against the grain, if I may so say, while the flesh resisted in a manner so forcible as to oppose & tire the hand of the operator, who was forced to change from the right to the left—then, indeed, I thought I must have expired. I attempted no more to open my Eyes—they felt as if hermetically shut, & so firmly closed, that the Eyelids seemed indented into the Cheeks. The instrument this second time withdrawn, I concluded the operation over—Oh no! presently the terrible cutting was renewed—& worse than ever, to separate the bottom, the foundation of this dreadful gland

from the parts to which it adhered—Again all description would be baffled—yet again all was not over—Dr. Larry rested but his own hand, &—Oh Heaven!—I then felt the Knife tackling against the breast bone—scraping it!—This performed, while I yet remained in utterly speechless torture, I heard the Voice of Mr. Larry,—(all others guarded a dead silence) in a tone nearly tragic, desire everyone present to pronounce if anything more remained to be done; the general voice was Yes,—but the finger of Mr. Dubois—which I literally felt elevated over the wound, though I saw nothing, & though he touched nothing, so indescribably sensitive was the spot—pointed to some further requisition—& again began the scraping!—and, after this, Dr Moreau thought he discerned a peccant atom—and still, & still, M. Dubois demanded atom after atom. My dearest Esther, not for days, not for Weeks, but for Months I could not speak of this terrible business without nearly again going through it! I could not think of it with impunity! I was sick, I was disordered by a single question—even now, nine months after it is over, I have a headache from going on with the account! & this miserable account, which I began three months ago, at least, I dare not revise, nor read, the recollection is still so painful. To conclude, the evil was so profound, the case so delicate, & the precautions necessary for preventing a return so numerous, that the operation, including the treatment & the dressing, lasted twenty minutes! a time, for sufferings so acute, that was hardly supportable—However, I bore it with all the courage I could exert, & never moved, nor stopt them, nor resisted, nor remonstrated, nor spoke—except once or twice, during the dressings, to say Ab Messieurs! que je vous plains!—for indeed I was sensible to the feeling concern with which they all saw what I endured, though my speech was principally—very principally meant for Dr. Larry. Except this, I uttered not a syllable, save, when so often they recommended, calling out Avertissez moi, Messieurs! avertissez moi! (“Tell me!”)—Twice, I believe, I fainted; at least, I have

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two total chasms in my memory of this transaction, that impede my tying together what passed. When all was done, & they lifted me up that I might be put to bed, my strength was so totally annihilated, that I was obliged to be carried, & could not even sustain my hands & arms, which hung as if I had been lifeless; while my face, as the Nurse has told me, was utterly colourless. This removal made me open my Eyes—& I then saw my good Dr Larry, pale nearly as myself, his face streaked with blood, its expression depicting grief, apprehension, & almost horror. When I was in bed,—my poor M. d’Arblay—who ought to write you himself his own history of this Morning—was called to me—& afterwards our Alex.

Suzanne White Junod, a historian with the Food and Drug Administration, has compiled an original review of health issues over which women consumers organized to obtain government protection. In 1933, Eleanor Roosevelt was so impressed by an FDA “Chamber of Horrors” exhibit of dangerous drugs and cosmetics that she “moved it directly to the White House and showed it to anybody who would look,” setting the stage for passage of the 1938 Food, Drugs, and Cosmetics Act. On the other hand, “the first state statutes regulating abortion were, in fact, poison control laws. The sale of commercial abortifacients was banned but not abortion per se.” In 1902, “the editors of the Journal of the American Medical Association endorsed a policy of denying medical care to a woman who was suffering from abortion complications until she ‘confessed.’ This practice prevented women from seeking timely medical treatment. By the late 1920s an estimated 15,000 women a year were dying from abortions.”

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omen have always taken the lead in protecting themselves and their families from impure foods and dangerous drugs and medical devices. In the last two centuries, largely as a result of pressure from women, government agencies have taken an increasing interest in women’s health issues: fertility, childbirth, menopause, geriatrics, and general nutrition and well-being. Following is a chronology of the regulation of products and devices affecting women’s health.

   ABORTION During the nineteenth century, the abor-

tion business, including the sale of widely advertised abortifacient drugs, was booming. Commercial preparations were so widely available that they inspired their own euphemism: “taking the trade.” The first state statutes regulating abortion were in fact poison-control laws. The sale of commercial abortifacients was banned, but not abortion per se. In June 1895, at the meeting of the Washington DC, Obstetrical and Gynecological Society, Dr. Joseph Taber Johnson encouraged his colleagues to begin a crusade against abortion. They had to convince both women and the medical profession that abortion was wrong. In 1902, the editors of the Journal of the American Medical Association endorsed a policy of denying medical care to a woman who was suffering from abortion complications until she “confessed.” This practice prevented women from seeking timely treatment. By the late 1920s, an estimated 15,000 women were dying from abortions each year. DRUGS AND UNSAFE ADDITIVES In 1880, Peter Collier,

chief chemist at the US Department of Agriculture, recommended a national food and drug law. Twelve years later, in 1892, the law (known as the Paddock bill) did pass the Senate, but it was not taken up by the House of Representatives. By the turn of the century, women were actively agitating against the use of opium, morphine, and laudanum in so-called baby-soothing syrups, used to calm colicky babies. Women’s groups (most no-

tably the General Federation of Women’s Clubs) and muckraking journalists also exposed the high alcohol content of most of the women’s proprietary “tonics.” Unlike men, who drank openly in saloons, women frequently became addicted to alcohol under the guise of self-medication and nursed their addictions surreptitiously at home. The Women’s National Labor League (later the National Women’s Industrial League) decided to take matters into their own hands by putting direct pressure on the National Wholesale Druggists Association at their annual convention in Washington DC. They tried to present the association with a petition that, in effect, called for full disclosure and honesty in advertising. Since the industrial classes could not always afford adequate medical care, said the league women, it was important that the proprietary remedies on which they depended should be reliable. Therefore, the products should be sold under fully informative labels that would show what was in them but not carry fraudulent claims about their therapeutic value. Furthermore, such products as Mrs. Winslow’s Soothing Syrup, which contained morphine and was innocently given to babies, should be taken off the market entirely. Haughtily the druggists told them that unless the reference to Mrs. Winslow’s was struck out, they would not entertain the petition. The women refused. They had drawn up the petition to express their own views, not to please the druggists; now they threatened to move on to Capitol Hill. Thoroughly alarmed, the druggists warned them that if they did anything of the kind and a clause directed against patent medicines found its way into the food and drug bill, the industry would spend half a million dollars to defeat the measure. Despite the druggists’ threat, the women went straight to Capitol Hill and informed members of Congress that it was not enough to prosecute the shippers who violated the law; their adulterated and misbranded merchandise had to be confiscated and destroyed as well. When the Food and Drug Act finally passed in 1906, it contained a provision

for the seizure of illegal foods and drugs, largely as a result of the women’s pressure. According to Ruth Lamb, who wrote American Chamber of Horrors in the 1930s advocating the need for a new federal food and drug statue: The full significance of this provision seems not to have been appreciated by anyone at the time, for it remained in succeeding food and drug bills and was finally enacted into law—to become the most hated and bitterly contested feature of the whole statute. To that perspicacious group of women in the 1890s, and their leader, Charlotte Smith, the public is forever indebted, for this single provision of the Food and Drugs Act has been, beyond all cavil, the government’s most powerful weapon against dangerous or fraudulent products. The drug-labeling provisions of the 1906 act required that the percentages of alcohol and other “dangerous” ingredients be clearly listed on the label. Although this early law did not make such products illegal, it did at least prevent them from being sold as “cures” for alcoholism. As a result, manufacturers generally reduced the amount of alcohol in their products and replaced the opium, laudanum, and morphine with less dangerous ingredients that did not have to be disclosed on the label itself.

    The Nineteenth Amendment granting women’s suffrage was ratified on August 18, 1920. This was also a time of important medical discoveries. In 1922, Banting, Best, Macleod, and Collip at the University of Toronto announced the discovery of insulin as a treatment of diabetes mellitus. Their first patient was a fourteen-year-old girl, who, after initiating injections of insulin, lived to the ripe old age of seventy-seven.

➤

By 1922, radical mastectomy, introduced by

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William Halsted, had become the standard “cure” for breast cancer. Lung tissue, but not the soft tissue of the breasts, could be seen on X-rays. In 1927, Aurel Babes published an article in France discussing the possibility of cancer diagnosis from vaginal smears. His method was substantially different from the one developed later by George Papanicolaou, who published his “New Cancer Diagnosis” a year later in the Proceedings of the Third Race Betterment Foundation. ➤

In 1927, Congress enacted the Caustic Poison Act requiring warning labels to protect children from accidental death and injury caused by lye and ten other caustic chemicals. The campaign for passage of the act was led by Dr. Chevalier Jackson and supported by the American Medical Association. The Food and Drug Administration (FDA) was given enforcement responsibilities.

➤

In 1928, Alexander Fleming discovered penicillin (which did not become available for widespread clinical use in civilian populations until 1945). Deaths from childbed or puerpheral fever dropped dramatically as a result of penicillin and other antibiotics. ➤

’     During the 1920s, as women became more active outside the home, the cosmetics industry grew out of obscurity into a multimillion-dollar industry. Women’s and consumer groups became concerned about the dangers of some of these new cosmetic products, notably hair dyes and rouges, as well as the safety of such devices as womb pessaries, bust enhancers, and nose straighteners; women’s “tonics”; and the unrestricted use of amphetamines and other weight reduction drugs. In the summer of 1933, the FDA set up an exhibit illustrating abuses in the sale of food, drugs, and cosmetics not covered by the Food and Drug Act of 1906. A number of the women’s beauty and diet aids in the exhibit—hair dyes, depilatories, pessaries, skin whiteners—contained CHAPTER 1: IN TH E BEG INNING

dangerous poisons such as lead, silver, pyrogallol, mercury, thyroid, thallium acetate, barium sulfide, and paraphenylene diamine. Other products made false or inflated claims. After viewing the exhibit, Eleanor Roosevelt took up the cause. She had the exhibit moved from the offices of the FDA directly to the White House and showed it to anybody who would look. But, according to a Washington Star account, “the politicians paid absolutely no attention to her. They regarded her as a nuisance and didn’t think that there were any votes involved in it, and she had no effect at all except as she worked through the women’s organizations. And, of course, she did this a lot.” She appealed to the nation’s women to join the campaign for a new, more all-encompassing law. This set the stage for the passage of the 1938 Food, Drug, and Cosmetics Act. The new law expanded the FDA’s regulatory powers. Under the 1906 act, thyroid preparations were a drug, but because obesity was not considered a disease, the agency could not act against these preparations. But under the new law, the FDA could act against drugs designed to change the structure of the body (thyroid increased metabolism). The new law also allowed action against radium waters and radiopharmaceuticals (previously thought to be “natural”) as well as nose straighteners and womb pessaries, all of which were now classified as drugs. The new law also had a direct impact on the quality of prophylactics. The FDA announced that regardless of the nature of the products, or the methods in which they were used, all articles intended as “venereal disease preventives” were subject to the provisions of the act, and that articles depending for their prophylactic effect on preventing contact with infecting organisms should be free from defects. In an extensive survey of rubber and membrane prophylactics, 181 consignments seized from nine manufacturers were found to be defective. As a result, producers withdrew much of their outstanding stocks and made drastic changes in their manufacturing processes.

Another product that had a great impact on women’s lives was the tampon. By 1921, there were at least sixteen patents for tampons and one for a tampon applicator. Their use was limited to the treatment of disease. In 1933, Dr. Earle Hass patented the tampon that was introduced three years later in improved form as the Tampax tampon. Doctors and nurses actively promoted disposable sanitary pads and tampons in the increasingly “antiseptic” culture. Women viewed these products as practical and labor-saving. By 1947, 538 gross dozens, with a value of $11,099,000 were shipped to retailers. Tampons had been accepted.

 :     By the 1940s, 26,000 American women were dying of uterine cancer every year. George Papanicolaou and Herbert Traut published “The Diagnostic Value of Vaginal Smears in Carcinoma of the Uterus” in the American Journal of Obstetrics and Gynecology. This article presented their technique for obtaining a smear and their theory of exfoliative cytology, which allows the interpretation of the smears and the detection of malignancy. The National Cancer Institute estimates that between 1950 and 1970, deaths from cervical cancer dropped 70 percent. The decrease in cancer deaths was a direct result of the Pap smear. Realizing the need for better breast imaging, Stafford Warren, a pioneer in radiation at the UCLA School of Medicine, developed a stereoscopic grid system for identifying malignant breast tumors. In 1949, John Wild applied ultrasound to distinguish malignant from healthy tissues. That same year, Paul Leborgne from Uruguay demonstrated the importance of high-contrast breast images in about 30 percent of the cases he examined, and established the value of breast compression in identifying benign and malignant breast tumors.

   In 1937, the New England Journal of Medicine carried an anonymous editorial discussing the possibility of conception in a watch glass as a future treatment of dysfunctional fallopian tubes. In 1940, Charles Huggins first reported the value of diethylstilbestrol (DES) in the treatment of prostate tumors. In 1944, after six years of intense experimentation, John Rock, a birth control pioneer, and a colleague claimed in vitro fertilization of a human ovum. The procedure and their results were accompanied with pictures and published in Science. In 1949, Barr and his colleagues noted that it was possible to distinguish male and female cells from the presence or absence of a small cellular body. Knowing the sex of the fetus had implications for families with histories of sexlinked diseases. No one could have predicted where all this would lead in the second half of the twentieth century.

A My Name Is Alice JENNIFER BAUMGARDNER Jennifer Baumgardner, excerpt from “My Name Is Alice: The Story of the Feminist Playmate,” MAMM, October/November 1998. Reprinted by permission.

 :     :   ’   Alice Denham, a fiercely independent and dazzling redhead with a master’s degree in English and a Phi Beta Kappa from the University of North Carolina, comes to the Big Apple to make it as a writer. From a poor but genteel Southern family, the pert but steely gamine applies for job after job in publishing. Within a few days of pounding the pavement in her pumps, Alice’s innocence is shattered: There aren’t any jobs for women in publishing in 1953. There might as well be a sign

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that says “Girls Keep Out!” hanging over the city rather than the promising glitter of the New York skyline at night. “Screw the bastards!” Alice declares as she pours herself a teacup full of whiskey and tries to work out plan B: the one where she can get the respect she deserves in this macho town. Or so Alice Denham’s story might begin if it was a novel written by Alice Denham herself. Still petite and red-haired with a drawl that suspends her words in honey and belies her Jacksonville, Florida upbringing, Denham really did move to New York City in the bohemian fifties to find that she couldn’t even get interviewed. “All they wanted was secretaries,” she says, doll-sized and grinning, dwarfed by the average-sized table of a West Village tea salon. “And I had purposefully not taken shorthand to avoid that fate.” Denham decided to focus on writing full-time. No one needed to give her permission to do that. “Writing was the only thing I ever wanted to be or to do, so I decided I would be a writer if it killed me.” All she needed in order to get started was a job that paid well and didn’t require a lot of time.

 :      “I was living with a friend who was an actress, and she introduced me to a model. People had asked me to pose for photos from time to time, and soon I started to be sent out for doing romance novel covers,” she says, as matter-of-factly as she had mentioned her undeserved reputation as a slut in college (the president of a powerful fraternity sought retribution after she refused to date him) and her breast cancer ten years ago (lying on her back, she noticed her breast was at a 90-degree angle) during the first few moments upon arriving. Modeling a few hours a week to pay the bills, she taught herself to write a novel during the rest of the week by observation, fiction technique books, and “trial and error.” Poring over Dostoyevsky in her Village apartment, Denham gleaned the magic of a strong lead, the art of withholding information,

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the importance of characterization. Still, “it took me a very long time to write my first novel.” She did, indeed, finish her novel, and a few more, but first came a serendipitous piece of fiction called “The Deal.” Originally published in the then-prestigious literary magazine Discovery, the story centers on a rich man who is so taken with a beautiful woman that he offers her $1,000 to sleep with him once. At that time (the mid-fifties) another magazine was printing serious (read: male) fiction: Playboy. Given her day job, our uppity heroine had an idea. “I told my literary agent to say that if Playboy would reprint the story, I would be the centerfold.” Soon Denham found herself at the Chicago airport, destined to be Miss July 1956, the only playmate to have a piece and be a piece in the same issue. “Hef met me at the airport. I thought he was the limo driver. He was so stiff and formal in his black suit that I got into the backseat of the car. He said, ‘Sit up front.’ I said, ‘What?’ He said, ‘I’m Hugh Hefner.’” Denham pauses for a moment and then dishes about the man responsible for sexualizing the girl next door. “He was a really silly man, running around in pajamas, and he never grew up,” she says, digging into her baked chicken breast. “Ultimately, we had sex,” she continues, with a sigh. “It was all right, though he had to watch dirty movies. All of this is in my novel Amo— except I changed the names. I called the magazine ‘Meat’ and I called the Playmates ‘Tidbits of the Month’ and I called him ‘Pelth Pedlar.’ ‘The Deal’ was her break. Still, Denham admits her family was horrified by her national exposure, despite how tame the shots were back in the early days of girlie mags. That is, except for her brother, an Episcopal preacher, who assured Denham that she looked very cute. “The only thing I cared about modeling was would it pay enough to cover my monthly expenses,” says the sixty-six-year-old. “The thing is, I wouldn’t have to resort to Playboy nowadays,” says Denham. “I could have been an assistant editor or a freelance writer.”

 :     ’   “I think all of my work has largely been about discrimination,” says Denham. “Social, gender, all that stuff, one way or another.” There was a thriving bohemian literary scene at the time of her arrival in New York, and Denham soon found herself amid the swirl. According to a piece in the New York Observer by Darius James, she dated James Jones, Philip Roth, spent a couple of “casual” evenings with Norman Mailer, and enjoyed a close “sexual friendship” with that fey icon of earlysixties cool, James Dean. But when it came time to blurb her book, these scribes of the masculine experience made themselves scarce. One assumes that Denham’s memoir-in-progress entitled Sleeping with the Boys will do a little toward righting that slight, but it just so happened that she had discovered another downtown intellectual scene— one more interested in her body of work than in her body. As an early second-wave feminist, Denham came to the movement as part of the campaign to legalize abortion (which occurred in 1970 in New York and 1973 nationally) and was part of the original National Organization for Women chapter. As an associate professor at John Jay College at the City University of New York during the seventies, Denham handled an Equal Employment Opportunity Commission discrimination case that was settled in the faculty women’s favor for $3.5 million. Always an independent, her work became even more confidently pro-woman. My Darling from the Lions concerned a feminist centerfold from outer space, and Amo chronicled a feminist’s mad passion for her tragically sexist husband. Meanwhile, a movie, Quizas, was made from the Playboy story.

Allende, Mexico, she discovered breast cancer. “I think diagnosis refocuses your head,” she says. “You no longer think so much about physical beauty or the beauty of your breasts. It’s whether you’re going to live or not.” The former model didn’t find that the mastectomy changed her body image so much; cancer affected her desire to create. “My work habits were always good, but I started working harder and faster. I wanted to complete all of these things that were halfway done.” Her current regimen is an hour of exercise upon waking, breakfast—“If my husband is home and doesn’t have work, he makes breakfast, washes the dishes, and then gets out of the house”—and then she writes all day.

 :   Alice Denham is working on a family saga called Shabby Genteel: A Southern Girlhood and the aforementioned memoir of her days in the Boho/prefeminist fifties and sixties. She spends summers in Mexico and the rest of the year in New York and writes and publishes in both locales. As for her cancer, there is no act two, but her last mammogram showed a burst of calcium which her doctors are watching for bad signs. Typically, Denham is candid about her mammography appointment. “They were going to do something awful called a mammotone where they lay you down on a table with your breast hanging down through a hole and they clamp it like a mammogram,” she says, eyes rolling. “After taking my breast photos in about a thousand different ways they decided they couldn’t do it because [the calcifications were] too close to the skin.” She snorts. “Have you ever had a mammogram?” she inquires, peering across the table with a half smile on her face. “You wait.”

 :  Then, ten years ago, when Denham was fifty-six and married for eight years to an accountant she had met in her part-time home of San Miguel de

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