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Women's Health Care

Women were especially vulnerable to inadequate diagnoses and treatment in 19th century America. It was commonly believed that most physical ailments of women were caused by their sexual organs or mental disorders, resulting in painful, sometimes lethal treatments. Despite these malpractices, some advances were made in the field of obstetrics and gynecology.

In1809 in Danville, Kentucky, Dr. Ephraim McDowell performed the world's first successful ovariotomy, removing a 22–pound ovarian tumor from Jane Todd Crawford as she was strapped to the kitchen table singing hymns to counteract the pain. Non-surgical cancer treatments suggested in medical texts of the day included injections of Castile soap suds for the treatment of ovarian cancer and taking emetics to clear the body of breast cancer. A plaster of extract of clover was to be placed on any exposed cancerous sores following the purging, a treatment considered a "simple, safe, and generally effectual remedy."

Childbirth during this period was marked by concern for pain in delivery and the cause of puerperal fever, which appeared mysteriously after deliveries and often led to quick death. Physicians were finally able to combat puerperal fever in the 1880s when they connected unclean instruments and doctors' hands with the high mortality rates. Ether and chloroform were used to alleviate the pain of childbirth, despite vigorous opposition by religious zealots who claimed anesthesia during birth was sacrilegious because it conflicted with God's dictum: "In sorrow shalt thou bring forth children." Birth pain, they said, was a curse upon women and suffering was necessary to induce maternal love. Some doctors agreed. Dr. Charles Meigs believed that "the female, at the most interesting period of her life, the time of labor, should, all other things being equal, have her mind unclouded, her intellect undisturbed, her judgment fully adequate to realize and appreciate the advent of a new and important era in her existence—the birth of her child."

Title page of A. M. Mauriceau's The Married Woman's Private Medical Companion.

Modesty and morality in Victorian America forestalled some advances in obstetrics and gynecology. During the 1820s, male midwives began to attend more births, an area previously dominated by women. Physical examinations during pregnancy, manipulations during childbirth, and the discussion of other female complaints created apprehension in both patient and doctor. Taboos against revealing the body also retarded clinical training in obstetrics until medical schools began to treat poor women for free in exchange for the right to expose them to students. Dr. J. Marion Sims, the father of American gynecology, perfected the technique of repairing tissue torn during difficult childbirths using poor black women whom he housed and fed as experimental subjects.

An early medical guide for women by H. B. Skinner titled The Female's Medical Guide and Married Woman's Adviser,published in 1849.

Female mental health problems were generally viewed as pathological. The Victorian view of females as weak, fragile, and childlike served as both cause and effect, creating generations of repressed, suffering women made worse by harsh treatment. Hysteria, the "daughter's disease," was common, and believed to be caused by aberrations in the reproductive system. The "rest cure," conceived by neurologist S. Weir Mitchell, was commonly practiced to cure hysteria. Prominent women who underwent the rest cure included Edith Wharton, Jane Addams, Winifred Howells, and Charlotte Perkins Gilman. Weir retracted his views on the rest cure after reading Gilman's nightmarish response to it in The Yellow Wallpaper.

Surgical cures for mental illness in women also were common. Dr. Isaac Baker Brown in 1858 proposed clitoridectomies to stop self-abuse, a treatment prescribed by Dr. Sims, among others. Dr. Robert Battey espoused removing ovaries to cure insanity in his work Female Castration (1873). At the opposite end of the spectrum, Dr. Alice B. Stockham believed all female problems were psychological, and asserted the mind could control even malignant tumors.

Robert Dale Owen and Charles Knowlton started the American birth control movement between 1828 and 1832. In 1830, Owen published Moral Physiology, the first book published in the country on birth control. Owen recommended the coitus interruptus method, as he considered the sponge method physically disagreeable and the condom inconvenient. Although the birth rate declined 20 percent between 1860 and 1880 among native-born, white women, this was not due to the quality of information available on birth control, but probably the result of the antisexual beliefs of the era. Women reared to feel disgust for their bodies and flattered into believing they were the moral sex controlled the birth rate by insisting upon long periods of sexual abstinence.

Many women continued to accept yearly, unregulated pregnancies as God's will and nature's course, but others saw pregnancy as a curse and lived in continual fear of conception. Some women attempted to terminate their pregnancies. Methods employed included jumping off of tables, rolling on the floor, massaging the stomach, taking abortifacients (discreetly sold as patent medicine cures for "female problems"), and using blunt instruments.

Bythe 1870s, birth control was known as "voluntary motherhood." It was advocated by suffragists, moral reformers influenced by Social Darwinism who espoused eugenics, and members of free-love communes. Birth control methods included male continence, Karezza (both woman and man avoiding climax), vaginal douches, purgatives, diaphragms, condoms, and spermicides.

The title page of Alice B. Stockham's book on birth control, Karezza,published in 1896.

Birth control often was advocated in the 19th century not as a way to limit the number of children produced, but as a means to better offspring through eugenics. Eugenics, the science of human breeding, combined scientific fact with America's optimistic millennial belief that the race and the country could be improved through reproduction control. Eugenicists sought to improve future generations by encouraging those with above average mental and physical traits to have more children, and those with below average traits to have fewer.

Methods suggested by eugenicists included segregating those with undesirable characteristics, like prisoners and mental patients, and instituting sterilization, birth control, and legal restraints on their marriage. O.S. Fowler, in his work Hereditary Descent, recommends who should marry and what temperaments and phrenological profiles should not unite. Fowler notes that "what is one's meat is another's poison." Others focused on ways ordinary people could improve their children through their sexual practices. John Cowan, in The Science of New Life, advocated the Law of Continence. According to Cowan, married couples should practice voluntary abstinence except for the purpose of procreation: one attempt every two years on a sunny August or September day when the electricity of the sun could combine with the electricity of the parents. All energy was then focused on conception, and afterwards the couple would return to sleeping in separate quarters until another two years had passed.

Eugenics never received widespread acceptance because many feared it took away basic human rights such as selecting one's spouse. Some believed reproduction control might be misused, and others objected for religious reasons. But eugenics did have some positive aspects in that it helped to sexually liberate Victorian America and advocated sex as an essential component of human character. Eugenics also implied that women should have some control over their lives, and some practitioners even promoted female sexual satisfaction as an integral part of reproduction.

Allen, Monfort B., and Amelia C. McGregor. The Glory of Women: Or Love, Marriage and Maternity. Philadelphia: Elliott Publishing Co., 1896.

Blundell, James. Lectures on the Principles and Practice of Midwifery. Philadelphia: E. Barrington & Geo. D. Hasell, 1842.

Burns, John. Observations on Abortion. Springfield, Massachusetts: Thomas Dickman, 1809.

Chavasse, Pye Henry. Ladies' Family Physician. Advice to a Wife and Mother. New York: John W. Lowell Company, 1873.

Cowan, John. The Science of a New Life. New York: Cowan & Company, 1871.

Curtis, Alva. Lectures on Midwifery and the Forms of Disease Peculiar to Women and Children. Columbus: Jonathan Phillips, 1837.

Fowler, O. S. Maternity: Or the Bearing and Nursing of Children. New York: Fowler & Wells, 1853.

Hard, M. K. Woman's Medical Guide; Being a Complete Review of the Peculiarities of the Female Constitution. Mt. Vernon, Ohio: W. H. Cochran, 1848.

Horton, Howard. Dr. Howard's Private Medical Companion, and Complete Midwife's Guide. St. Louis: C. Drew & Co., 1860.

Lyman, Eliza Barton. The Coming Woman: Or, the Royal Road to Physical Perfection. Lansing, Michigan: W. S. George & Co., 1880.

Mauriceau, A. M. The Married Woman's Private Medical Companion. New York: 1850.

Melendy, Mary R. Perfect Womanhood for Maidens-Wives-Mothers. Chicago: Monarch Book Co., 1903.

Napheys, George. H. The Physical Life of Woman: Advice to Maiden, Wife, and Mother. Philadelphia: George Maclean & Co., 1871.

Napheys, George H. The Transmission of Life. Counsels on the Nature and Hygiene of the Masculine Function. Philadelphia: David McKay, 1893.

Pancoast, Seth. The Ladies' New Medical Guide: An Instructor, Counsellor and Friend. Philadelphia: John E. Potter & Co., 1890.

Saur, Prudence B. Maternity: A Book for Every Wife and Mother. Chicago: Monarch Book Co., 1889.

Skinner, H. B. The Female's Medical Guide and Married Woman's Adviser.Boston: Skinner's Publication Room, 1849.

Solis-Cohen, Myer. Woman in Girlhood-Wifehood-Motherhood. Philadelphia: J. C. Winston, 1906.

Stockham, Alice B. Karezza: Ethics of Marriage. New York: R. F. Fenno & Co., 1896.

Stockham, Alice B. Tokology: A Book for Every Woman. Chicago: Alice B. Stockham & Co., 1890.

Storer, Horatio Robinson. Why Not? A Book for Every Woman. Boston: Lee and Shepard, 1866.

Trall, Russell. T. Sexual Physiology: A Scientific and Popular Exposition of the Fundamental Problems in Sociology. New York: Wood & Holbrook, 1877.

Verdi, Tullio Suzzara. Mothers and Daughters: Practical Studies for the Conservation of Health of Girls. New York: J. B. Ford & Co., 1877.

West, John D. Maidenhood and Motherhood: Or Ten Phases of Woman's Life. Chicago: King Publishing Co., 1889.

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