For many other women, to various degrees, sickness became a part of life, even a way of filling time. The sexuo-economic relation confined women to the life of the body, so it was to the body that they directed their energies and intellect. Rich women frequented resortlike health spas and the offices of elegant specialists like S. Weir Mitchell. A magazine cartoon from the eighteen seventies shows two “ladies of fashion” meeting in an ornately appointed waiting room. “What, you here, Lizzie? Why, ain’t you well?” asks the first patient. “Perfectly thanks!” answers the second. “But what’s the matter with you, dear?” “Oh, nothing whatever! I’m as right as possible dear.”16 For less well-off women there were patent medicines, family doctors, and, starting in the eighteen fifties, a steady stream of popular advice books, written by doctors, on the subject of female health. It was acceptable, even stylish, to retire to bed with “sick headaches,” “nerves,” and various unmentionable “female troubles,” and that indefinable nervous disorder “neurasthenia” was considered, in some circles, to be a mark of intellect and sensitivity. Dr. Mary Putnam Jacobi, a female regular physician, observed impatiently in 1895:
… it is considered natural and almost laudable to break down under all conceivable varieties of strain—a winter dissipation, a houseful of servants, a quarrel with a female friend, not to speak of more legitimate reasons.… Women who expect to go to bed every menstrual period expect to collapse if by chance they find themselves on their feet for a few hours during such a crisis. Constantly considering their nerves, urged to consider them by well-intentioned but short-sighted advisors, they pretty soon become nothing but a bundle of nerves.17
But if sickness was a reaction, on women’s part, to a difficult situation, it was not a way out. If you have to be idle, you might as well be sick, and sickness, in turn, legitimates idleness. From the domestic perspective, the sick woman was not that far off from the ideal woman anyway. A morbid aesthetic developed, in which sickness was seen as a source of female beauty, and, beauty—in the high-fashion sense—was in fact a source of sickness. Over and over, nineteenth-century romantic paintings feature the beautiful invalid, sensuously drooping on her cushions, eyes fixed tremulously at her husband or physician, or already gazing into the Beyond. Literature aimed at female readers lingered on the romantic pathos of illness and death; popular women’s magazines featured such stories as “The Grave of My Friend” and “Song of Dying.” Society ladies cultivated a sickly countenance by drinking vinegar in quantity or, more effectively, arsenic.18 The loveliest heroines were those who died young, like Beth in Little Women, too good and too pure for life in this world.
Meanwhile, the requirements of fashion insured that the well-dressed woman would actually be as frail and ornamental as she looked. The style of wearing tight-laced corsets, which was de rigueur throughout the last half of the century, has to be ranked somewhere close to the old Chinese practice of footbinding for its crippling effects on the female body. A fashionable woman’s corsets exerted, on the average, twenty-one pounds of pressure on her internal organs, and extremes of up to eighty-eight pounds had been measured.19 (Add to this the fact that a well-dressed woman wore an average of thirty-seven pounds of street clothing in the winter months, of which nineteen pounds were suspended from her tortured waist.20) Some of the short-term results of tight-lacing were shortness of breath, constipation, weakness, and a tendency to violent indigestion. Among the long-term effects were bent or fractured ribs, displacement of the liver, and uterine prolapse (in some cases, the uterus would be gradually forced, by the pressure of the corset, out through the vagina).
To be sure, the nineteenth-century romantic spirit put women on a pedestal and ascribed to her every tender virtue absent from the Market. But carried to an extreme, the demand that woman be a negation of man’s world left almost nothing for women to actually be: if men are busy, she is idle; if men are rough, she is gentle; if men are strong, she is frail; if men are rational, she is irrational; and so on. The logic that insists that femininity is negative masculinity necessarily romanticizes the moribund woman and encourages a kind of paternalistic necrophilia. In the nineteenth century this tendency becomes overt, and the romantic spirit holds up as its ideal—the sick woman, the invalid who lives at the edge of death.
Femininity as a Disease
The medical profession threw itself with gusto on the languid figure of the female invalid. In the home of an invalid lady, “the house physician like a house fly is in chronic attention”21 and the doctors fairly swarmed after wealthy patients. Few were so successful as S. Weir Mitchell in establishing himself as the doctor for hundreds of loyal clients. Yet the doctors’ constant ministrations and interventions—surgical, electrical, hydropathic, mesmeric, chemical—seemed to be of little use. In fact, it would have been difficult, in many cases, to distinguish the cure from the disease. Charlotte Perkins Gilman of course saw the connection. The ailing heroine of The Yellow Wallpaper, who is being treated by her physician-husband, hints at the fearful truth:
John is a physician, and perhaps—(I would not say it to a living soul, of course, but this is dead paper and a great relief to my mind)—perhaps that is one reason I do not get well faster.22
In fact, the theories which guided the doctor’s practice from the late nineteenth century to the early twentieth century held that woman’s normal state was to be sick. This was not advanced as an empirical observation, but as physiological fact. Medicine had “discovered” that female functions were inherently pathological. Menstruation, that perennial source of alarm to the male imagination, provided both the evidence and the explanation. Menstruation was a serious threat throughout life—so was the lack of it. According to Dr. Engelmann, president of the American Gynecology Society in 1900:
Many a young life is battered and forever crippled on the breakers of puberty; if it crosses these unharmed and is not dashed to pieces on the rock of childbirth, it may still ground on the ever-recurring shallows of menstruation, and lastly upon the final bar of the menopause ere protection is found in the unruffled waters of the harbor beyond reach of sexual storms.23
Popular advice books written by physicians took on a somber tone as they entered into “the female functions” or “the diseases of women.”
It is impossible to form a correct opinion of the mental and physical suffering frequently endured from her sexual condition, caused by her monthly periods, which it has pleased her Heavenly Father to attach to woman.…24
Ignoring the existence of thousands of working women, the doctors assumed that every woman was prepared to set aside a week or five days every month as a period of invalidism. Dr. W. C. Taylor, in his book A Physician’s Counsels to Woman in Health and Disease, gave a warning typical of those found in popular health books of the time:
We cannot too emphatically urge the importance of regarding these monthly returns as periods of ill health, as days when the ordinary occupations are to be suspended or modified.… Long walks, dancing, shopping, riding and parties should be avoided at this time of month invariably and under all circumstances.…25
As late as 1916, Dr. Winfield Scott Hall was advising:
All heavy exercise should be omitted during the menstrual week … a girl should not only retire earlier at this time, but ought to stay out of school from one to three days as the case may be, resting the mind and taking extra hours of rest and sleep.26
Similarly, a pregnant woman was “indisposed,” throughout the full nine months. The medical theory of “prenatal impressions” required her to avoid all “shocking, painful or unbeautiful sights,” intellectual stimulation, angry or lustful thoughts, and even her husband’s alcohol and tobacco-laden breath—lest the baby be deformed or stunted in the womb. Doctors stressed the pathological nature of childbirth itself—an argument which also was essential to their campaign against midwives. After delivery, they insisted on a protracted period of convalescence mirroring the “confinement” which preceded birth. (Childbirth, in t
he hands of the medical men, no doubt was “pathological,” and doctors had far less concern about prenatal nutrition than they did about prenatal “impressions.”) Finally after all this, a woman could only look forward to menopause, portrayed in the medical literature as a terminal illness—the “death of the woman in the woman.”
Now it must be said in the doctors’ defense that women of a hundred years ago were, in some ways, sicker than the women of today. Quite apart from tight-lacing, arsenic-nipping, and fashionable cases of neurasthenia, women faced certain bodily risks which men did not share. In 1915 (the first year for which national figures are available) 61 women died for every 10,000 live babies born, compared to 2 per 10,000 today, and the maternal mortality rates were doubtless higher in the nineteenth century.27 Without adequate, and usually without any, means of contraception, a married woman could expect to face the risk of childbirth repeatedly through her fertile years. After each childbirth a woman might suffer any number of gynecological complications, such as prolapsed (slipped) uterus or irreparable pelvic tear, which would be with her for the rest of her life.
Another special risk to women came from tuberculosis, the “white plague.” In the mid-nineteenth century, TB raged at epidemic proportions, and it continued to be a major threat until well into the twentieth century. Everyone was affected, but women, especially young women, were particularly vulnerable, often dying at rates twice as high as those of men of their age group. For every hundred women aged twenty in 1865, more than five would be dead from TB by the age of thirty, and more than eight would be dead by the age of fifty.28
So, from a statistical point of view, there was some justification for the doctors’ theory of innate female frailty. But there was also, from the doctors’ point of view, a strong commercial justification for regarding women as sick. This was the period of the profession’s most severe “population crisis.” (See Chapter 3.) The theory of female frailty obviously disqualified women as healers. “One shudders to think of the conclusions arrived at by female bacteriologists or histologists,” wrote one doctor, “at the period when their entire system, both physical and mental, is, so to speak, ‘unstrung,’ to say nothing of the terrible mistakes which a lady surgeon might make under similar conditions.”29 At the same time the theory made women highly qualified as patients. The sickly, nervous women of the upper or middle class with their unending, but fortunately nonfatal, ills, became a natural “client caste” to the developing medical profession.
Meanwhile, the health of women who were not potential patients—poor women—received next to no attention from the medical profession. Poor women must have been at least as susceptible as wealthy women to the “sexual storms” doctors saw in menstruation, pregnancy, etc.; and they were definitely much more susceptible to the hazards of childbearing, tuberculosis, and, of course, industrial diseases. From all that we know, sickness, exhaustion, and injury were routine in the life of the working-class woman. Contagious diseases always hit the homes of the poor first and hardest. Pregnancy, in a fifth- or sixth-floor walk-up flat, really was debilitating, and childbirth, in a crowded tenement room, was often a frantic ordeal. Emma Goldman, who was a trained midwife as well as an anarchist leader, described “the fierce, blind struggle of the women of the poor against frequent pregnancies” and told of the agony of seeing children grow up “sickly and undernourished”—if they survived infancy at all.30 For the woman who labored outside her home, working conditions took an enormous toll. An 1884 report of an investigation of “The Working Girls of Boston,” by the Massachusetts Bureau of Statistics of Labor, stated:
… the health of many girls is so poor as to necessitate long rests, one girl being out a year on this account. Another girl in poor health was obliged to leave her work, while one reports that it is not possible for her to work the year round, as she could not stand the strain, not being at all strong.31
Still, however sick or tired working-class women might have been, they certainly did not have the time or money to support a cult of invalidism. Employers gave no time off for pregnancy or recovery from childbirth, much less for menstrual periods, though the wives of these same employers often retired to bed on all these occasions. A day’s absence from work could cost a woman her job, and at home there was no comfortable chaise longue to collapse on while servants managed the household and doctors managed the illness. An 1889 study from Massachusetts described one working woman’s life:
Constant application to work, often until 12 at night and sometimes on Sundays (equivalent to nine ordinary working days a week), affected her health and injured her eyesight. She … was ordered by the doctor to suspend work … but she must earn money, and so she has kept on working. Her eyes weep constantly, she cannot see across the room and “the air seems always in a whirl” before her … [she] owed when seen three months’ board for self and children … She hopes something may be done for working girls and women, for, however strong they may be in the beginning, “they cannot stand white slavery for ever.”32
But the medical profession as a whole—and no doubt there were many honorable exceptions—sturdily maintained that it was affluent women who were most delicate and most in need of medical attention. “Civilization” had made the middle-class woman sickly; her physical frailty went hand-in-white-gloved-hand with her superior modesty, refinement, and sensitivity. Working-class women were robust, just as they were supposedly “coarse” and immodest. Dr. Lucien Warner, a popular medical authority, wrote in 1874, “It is not then hard work and privation which make the women of our country invalids, but circumstances and habits intimately connected with the so-called blessings of wealth and refinement.”
Someone had to be well enough to do the work, though, and working-class women, Dr. Warner noted with relief, were not invalids: “The African negress, who toils beside her husband in the fields of the south, and Bridget, who washes, and scrubs and toils in our homes at the north, enjoy for the most part good health, with comparative immunity from uterine disease.”33 And a Dr. Sylvanus Stall observed:
At war, at work, or at play, the white man is superior to the savage, and his culture has continually improved his condition. But with woman the rule is reversed. Her squaw sister will endure effort, exposure and hardship which would kill the white woman. Education which has resulted in developing and strengthening the physical nature of man has been perverted through folly and fashion to render woman weaker and weaker.34
In practice, the same doctors who zealously indulged the ills of wealthy patients had no time to spare for the poor. When Emma Goldman asked the doctors she knew whether they had any contraceptive information she could offer the poor, their answers included, “The poor have only themselves to blame; they indulge their appetites too much,” and “When she [the poor woman] uses her brains more, her procreative organs will function less.”35 A Dr. Palmer Dudley ruled out poor women as subjects for gynecological surgery on the simple ground that they lacked the leisure required for successful treatment:
… the hardworking, daily-toiling woman is not as fit a subject for [gynecological surgery] as the woman so situated in life as to be able to conserve her strength and if necessary, to take a long rest, in order to secure the best results.36
So the logic was complete: better-off women were sickly because of their refined and civilized lifestyle. Fortunately, however, this same lifestyle made them amenable to lengthy medical treatment. Poor and working-class women were inherently stronger, and this was also fortunate, since their lifestyle disqualified them for lengthy medical treatment anyway. The theory of innate female sickness, skewed so as to account for class differences in ability to pay for medical care, meshed conveniently with the doctors’ commercial self-interest.
The feminists of the late nineteenth century, themselves deeply concerned about female invalidism, were quick to place at least part of the blame on the doctors’ interests. Elizabeth Garrett Anderson, an American woman doctor, argued that the extent of female invalidism wa
s much exaggerated by male doctors and that women’s natural functions were not really all that debilitating. In the working classes, she observed, work went on during menstruation “without intermission, and, as a rule, without ill effects.”37 Mary Livermore, a women’s suffrage worker, spoke against “the monstrous assumption that woman is a natural invalid,” and denounced “the unclean army of ‘gynecologists’ who seem desirous to convince women that they possess but one set of organs—and that these are always diseased.”38 And Dr. Mary Putnam Jacobi put the matter most forcefully when she wrote in 1895, “I think, finally, it is in the increased attention paid to women, and especially in their new function as lucrative patients, scarcely imagined a hundred years ago, that we find explanation for much of the ill-health among women, freshly discovered today.…”39
Men Evolve, Women Devolve
But it would be overly cynical to see the doctors as mere businessmen, weighing theories of female physiology against cash receipts. The doctors of the late nineteenth century were also men of science, and this meant, in the cultural framework that equated science with goodness and morality, that doctors saw themselves almost as moral reformers. They (and members of the new field of psychology) saw it as their mission to bring the clear light of scientific objectivity to the Woman Question, even when all others were gripped by passionate commitments to one answer or another. “The most devoted patron of woman’s political and educational advancement,” wrote psychologist George T. Patrick:
would hardly deny that the success and permanency of the reform will depend in the end upon the fact that there shall be no inherent contradiction between her duties and her natural physical and mental constitution.40
For Her Own Good: Two Centuries of the Experts Advice to Women Page 14