This talk is a bit of an experiment in that it will move between a few different registers. If you come back in August for the conclusion of my residency—which I hope you do—what I will present at that time will be almost entirely creative product, more of a traditional poetry reading with other artistic elements. But, given that those pieces in progress are so based in history, and that my artistic practice as well is grounded in source material, it felt like an injustice both to you as the audience and potential reader and an injustice to the real women whose stories are the foundation of my research to not provide a historical framework for the poetry that is in progress as part of this residency. So, this talk will try to do a bit of both, but will lean more heavily towards the historical, providing a solid foundation in the past from which to approach the poetry that develops out of the research.
So let’s begin.
A real woman becomes all the more womanly in ameliorating the suffering of others.
The woman’s body. Our shared familiar beginning. For all of us. And though no matter how common, it’s a body equally unknown to us. We encounter it in crisis, our memory of it, is one of asking for air. It at once gives us life and demands of us the urge to claim life for ourselves.
The mysteries of the woman’s body—its relationship to life and death, the phoenix that bleeds to live again, we all know these mythically marked women as goddess, priestess, witch, or sinful, curious gardener.
But when Eve’s daughters gave birth to future generations, who would attend to them at their bedside? Only women could attend to the mysteries of women. First-hand experience and domestic convenience made women the ideal attendants for the most foundational medical issue of life—birth. But, as you will see, things change along the course from midwife to obstetrician.
This work, my work, is not entirely original; it seeks to weave the threads of many stories, quotations, and reflections into a piece that reveals the complications, contradictions, and roundabout passages that bring the profession to acknowledge women fully as medical practitioners. We sit here at a time when questions about the value of and rights to health care, as well as questions about the equity and treatment of women, are at the center of public debate, but while my work is not intended to be political, it’s impossible to not instinctually acknowledge the present when approaching these topics.
I came to the Museum with a love of medical and surgical and scientific language, which I’ve been drawn to again and again in my work. We think science is precision and so is poetry, yet, they are both at home with metaphor. They both express by relationship to, by gesturing to an off- stage shadow, by conjuring through a trapdoor an apparition. They make present while unmaking the present. They stitch and dissect in cyclical turns.
My more recent work has been focused on the patient’s perspective of treatment, the view from the table, staring into the lights. But here, at the Museum, my hope was to come to understand the responsibilities, fears, and concerns of the person holding the knife, the person who carries the guilt and the mission in her hands. And specifically, I hoped to follow the path that led women into the medical profession itself. She may be known as the caregiver, but yet is called the sickly one. This woman is simultaneously a mender and the carrier of hysterical frailty.
The work I am creating moves between many voices—of the pioneering women doctors, of their male contemporaries—skeptical and supportive, as well as my own voice. And here, for this talk, I bring in not only these threads, but also a few historians to help establish the story.
Remember that you must do your utmost to banish fear and inspire hope
Our wounds, ourselves
The idea that the heart is frail
is a myth
How do we answer this question:
My body makes life and death
The power to live is greater in the female than in the male. Not all the evils of society and perils of childbirth have been able to affect the balance against woman. It is the power of adaptation to surroundings that has made woman survive in spite of circumstances.
What everyone should know
handy ways of doing, making, mending
We, who are so much damage
would we venture to go on
knowing what was before us
There really is no sex in science. Which Mary are you? The pure? The sinful?
In the late 18th century, the idea of an “exaggerated female delicacy” took hold, and the image of women “shifted from that of a being innately sensual” (our Mary Magdalene) to an idea of women as inherently “moral.” (our Lady Help) (Morantz-Sanchez 1985) Women were no longer seen as a group that was destined to lead men to their ruin through temptation, but they were the keepers of men’s—and thus society’s morality. If a woman could lead a man to sensual destruction, she could also lock herself up under layers and layers of chaste fabric, turning a stern eye to men and their urges.
Whether or not this was good for the soul, I’ll leave to the Victorians to answer, but what can be known for a fact—is it was certainly detrimental for the body. In fact, as this notion of a chaste or at least, passionless, woman proliferated, “it often turned the virtues of innocence and purity into . . . ignorance and prudery.” As a result, “Victorian delicacy threatened to make it difficult for physicians to treat their women patients at all.” (Morantz-Sanchez 1985)
For treatment, in this case, would require exposing the female body to the intimate gaze and wanton hands of a man.
And for a time, midwives were able to use this prudish logic to maintain their practices, arguing that allowing men into the lying-in chamber would destroy “the moral fabric of society by compromising female modesty.” (Morantz-Sanchez 1985) Social conservatives and progressives in favor of women’s role in medical care found themselves unexpectedly with a common cause.
However, after 1830, advances in anatomical and medical knowledge—educational experiences that were mostly closed off to women—allowed male practitioners to challenge midwives and gave them the tools—quite literally—to assert their professional authority.
“By the middle of the 18th century, improvements in the use of forceps provided a major breakthrough in obstetrical practice and threatened the dominance of midwives.” (Morantz-Sanchez 1985)
Following on this, “Once the public had come to accept licensing and college training as guarantees of up-to-date practice, the outsider (in this case the midwife), no matter how well qualified by years of experience, and stood no chance in the competition. Women were the casualties of medical professionalization,” in this way. (Walsh 1977)
But what is a woman patient to do? Does she compromise her very clean soul by seeing a male doctor who might be able to save her life and the life of her child in the event of a difficult birth? Or does her modesty prevent her from seeking help?
I share a not-so sympathetic quote from Charles Meigs, professor of obstetrics and diseases of women and children at Jefferson Medical College in Philadelphia, 1848: “I confess I am proud to say that, in this country. . . . there are women who prefer to suffer the extremity of danger and pain, rather than waive those scruples of delicacy which prevent their maladies from being fully explored. I’d say it is an evidence of the dominion of a fine morality in our society.” (Walsh 1977)
In this fine morality, the balance between modesty and medicine does seem to be a tricky one.
“At one point, Dr. William Smellie, a British pioneer in obstetrics, went so far as to suggest that male midwives wear a feminine costume, a loose sort of nightgown, to ease the fears of their patients.” (Walsh 1977)
But this terribly futile situation—of risking death or risking modesty—did not go unanswered by women. Elizabeth Blackwell, who is well known as the first woman to receive a medical degree in the US, in 1849—one year after Dr. Meig’s horrific statement, notes that in part her own inspiration to become a doctor came from the story a friend. Blackwell says that “This friend finally died of a painful disease, the delicate nature of which made the methods of treatment a constant suffering to her. . . . She once said to me, “If I could have been treated by a lady doctor, my worst sufferings would have been spared me.” (Rosen 1947)
So, this begs the question—why not train women in medicine? Why not rush out in the interests of public health and train an equal number of women doctors?
There is a lot of confusion about whether
we are delicate creatures
whether blood is our magic or our curse
We carry wounds but cannot heal them
Women sometimes expel conceptions
like the wind egg
Some say they are called fluxes
among ourselves, they might be slips
In the same way as iron
touched by a magnet is endowed
with its power and can attract
other iron to itself, do we conceive
as we see by the eye and think by the brain
Like fruit by the summer’s heat
brought to the highest pitch
or like the spider’s web
Just as a desire arises
so too the painter pictures a face
so also the builder constructs a house
so the surgeon makes it whole
Birds immured in cages recall
to mind the spring and chant the songs
they had learned another year
Are we impregnated by an idea
and become the artificer of a generation
Is this what we might call that
If women may learn of men, why may they not learn with men.
In her book, Sympathy and Science, historian Regina Morantz-Sanchez writes “Before anesthesia the possible necessity of inflicting physical pain on patients was a part of the daily reality of professional practice and constituted an integral feature of the self-image and ideology of physicians. . . . the two professional requisites for a surgeon were a strong stomach and a willingness to ‘cut like an executioner.’” (Morantz-Sanchez 1985)
And so, our delicate Victorian woman was thought to possess way too much sympathy toward any potential patients to act with the cold restraint necessary of a doctor, of course this wasn’t a time known for its bedside manner. And let’s not even imagine, some men said, how such a creature might fare amid the wet and sticky guts and brains of the dissecting room.
But once again, the contradictions of Victorian society rub up against each other until they wear away a loophole. Enter the rise of preventive medicine. It was a new thought—Illness was not necessarily an act of god, but may be the direct consequence of the ways in which we live. And in fact, many illnesses could be prevented, many specifically prevented with good hygiene. This put the responsibility for health in the hands of each individual who was now no longer at the mercy of the random rules of nature.
At the forefront of this burgeoning health reform movement was the American Physiological Society founded in Boston in 1837 to promote health and longevity by promoting a kind of self-help approach to health and hygiene. Importantly, nearly a third of the original members of the Society were women, and at its second annual meeting, they passed the following resolution:
“That woman in her character as wife and mother is only second to the Diety in the influence that she exerts on the physical, intellectual, and the moral interests of the human race, and that her education should be adapted to qualify her in the highest degree to cherish those interests in the wisest and best manner.” (Walsh 1977)
In the Victorian cult of domesticity—which I should pause and acknowledge is definitely a conception tied to class—when we speak of this popular idea of true womanhood, it’s something that was cultivated among a leisured middle and upper class, one that had the economic freedom to be idle. But within this class, a true woman was thought to possess: piety, purity, submissiveness, and domesticity.
And if good health begins at home, as the reform movement stressed, women could be the keepers of not only our pristine souls but also the environments that made clean or hygienic living possible. With this came a lot of responsibility for women, but it also came with an important realization that knowledge was domestic power and that in order to be the true helpmates of men, women needed to be healthy and informed. And consequently, the health reform movement provided an acceptable realm in which women could be both educated and feel a sense of purpose.
Health reform and feminism thus became interrelated. With this came new dictates of practical dress, and you’ll see a lot of guidance for fashion in these early reform journals: overly fashionable clothes and shoes and tight lacing immobilized women and kept them from pursuing greater tasks. Revolutionary women, leading the reform movements, adopted the bloomer dress, which is later picked up by female doctors who are trying in their own way to blend in.
Despite this encouragement, at the same, Edmund Andrews writes in the Chicago Medical Examiner in 1861, “The primary requisite of a good surgeon is to be a man, a man of courage.” But other issues began to outweigh the questions of gender. That very same year, 1861, those men of courage were being called to another realm—not of care, but of war.
The consequences of war—in this case the US Civil War—and its inevitable shift in gender balance and roles, created not only the necessity of women caregivers in the field, but also the necessity to care for widows and children of soldiers.
Inspired by need, urgency, and curiosity, some women look beyond the domestic health reform movements and see a real opportunity to be educated in medical science and to seek out the occupation to care for others.
Here in Chicago, Mary Harris Thompson founded the Chicago Hospital for Women and Children in 1865 to provide medical care to needy women and children and”—most important— “clinical training to women doctors. The first patients were the wives, widows, and children of Union soldiers.” (Grossman 2004)
Hers was in fact the first hospital for women and children west of the Allegheny Mountains. Thompson herself had graduated in 1863 from the New England Female Medical College, which was founded in Boston in 1852, and boasted some early protégés of Blackwell on faculty.
The gospel of work is full of cure
Occupation a prescription
Let a delicate lady learn
as a young child would learn
let her creep and then go
Life itself is a forced state of being
caused by a preponderance of vital force
Every atom of the body having a constant tendency
to revert back to its original elements
This change taking place
in the entire body produces death
in but a portion of the body
The more pleasure we take, the more we crave it
To make us more beautiful
They put the cup of knowledge to our lips
Just a sip to make us blush
But the sipping excited a great thirst
not satisfied till the cup was drained
A little knowledge proved a dangerous thing
By allowing the mind to be exercised at all
it exercised all
We think there is no comparison in the moral effect on the sexes of a day’s work in the dissecting-room and a night’s revelry in the ball-room.
Though on one hand the professionalization of medicine, forced midwives out of medical practice, it can also be argued that it was the professionalization of medicine that made it possible for women to become doctors at all. By creating an established set of educational requirements and licensing guidelines, a specific path was created for anyone who wanted to be a doctor—the obstacles and challenges were delineated and thus a strategy could be made to meet the requirements.
And so, to support the Chicago Hospital for Women and Children, there needed to be educated staff, and in 1871, Dr. Thompson and Dr. William H. Byford established an affiliated medical school for women, the Women’s Hospital Medical College.
The History of Medical Practice in Illinois describes the first years of Thompson’s Medical College so:
“The first regular course of lectures was delivered in the parlors and dispensary of the hospital, and the dissecting room was a loft, reached by four flights of stairs, in an old building by the river. But to the enthusiasts this did not matter . . . .The school opened with 17 matriculants and the session was considered a real success.” (Davis 1955)
Among those early students was Sarah Hackett Stevenson, born in 1841 in Buffalo Grove, she graduated in 1874 from the college, after studying in London for a year with Thomas Huxley.
A year later, she was elected to the Chicago Medical Society and was a delegate to the state meeting. An observer at the time reported on the scene:
“Jacksonville, IL, Steps of the Hospital for the Insane: Innumerable high silk hats are seen, and one woman with full sweeping skirts and a wee umbrella. Dr. Sarah H. Stevenson of Chicago had been elected to membership; perhaps it was she.” (Davis 1955)
The Illinois Medical Society, as a whole, was an unexpected champion of Stevenson’s work, and in the following year, 1876, they sent her as a delegate to the national meeting of the American Medical Association in Philadelphia, where she became the first woman member of the House of Delegates of the AMA.
When Stevenson arrives at the meeting as the first woman delegate, the proceedings present a very charged scene, one with a lot of debate, and the Illinois Medical History specifically notes that “so much time was wasted on the Negro and the woman questions.” And this historical record does not paint a picture of a comfortable or welcoming environment:
“Dr. Stevenson, perhaps with remarkable wisdom, must have sat peculiarly quiet throughout the session, since her name does not appear as a participant in the making of motions, the offering of resolutions, the discussion of any papers or the presentation of any contribution.”
Though she may have been quiet then, she wasn’t quiet for long. Stevenson becomes one of the most vocal advocates both in Illinois and in the country for the teaching of medicine to men and women alongside each other, arguing that it seems counterproductive to teach them separately. Doctors of both sexes will treat patients of both sexes, and so there is no reason why they can’t learn together.
As Stevenson noted: “I hope that men and women will be educated in one institution—educated as physicians without any regard to the sex question at all. It seems to me, if we be physicians, that the first necessity is equality of opportunity, and that is all the woman physician asks.”
And in her essay, “Coeducation of the Sexes in Medicine” Stevenson argues: “If woman originally was the equal of man, how did it become possible for him to enslave her? We must admit physical inferiority, but with an important modification, viz., the inferiority is one of quantity, not quality. . . An elephant is larger and stronger than a horse; so is an ox; but it is the quality of the motor apparatus of the horse which makes him preferred to either as a beast of burden.
Judging from the amount of gray matter in the brain of woman, we should say it was placed there to be used.”
Adapted to become brain workers
The most timid of us grow brave
and courageous under the influence
and those naturally courageous
grow timid under idleness
and foolish sympathy
Fear makes us more gentle obligers
We’ve been advised
A lady should walk early in the morning
and not late in the evening
The dews of the dusk are dangerous
They said we ought to avoid all recreations
of an exciting kind, as depression
always follows excitement
The wild animal may lie in your arms
and peacefully lick your hand
but not for your life dare you
let the smell of blood come to its nostrils
Our minds have been thought to sleep
When this project concludes in August, this slumber will have been proven to be only a hibernation at best. At that time, I will bring together the research into a fully lyric form through a series of artist books, handmade and hand-sutured, and with text that engages with the many voices and perspectives of the professionals, both men and women, at the time. There is also one story not yet touched on here, that of Alice Magaw, whose portrait hangs in the Museum. She was a graduate of the nursing school which Stevenson herself helped establish as an offshoot of the Chicago Women’s Hospital Medical College, and Magaw was nicknamed by Charles Mayo the “mother of anesthesia.” The relationship between women and suffering (it’s origins in childbirth and the idea that pain was natural and an obligation) and the rise of a particular woman as a master of the amelioration of pain is something I’ll explore in more detail for the final piece of my work.
As well, at the end, alongside the poetic work, I will present in collaboration with dancer and choreographer Edson Cabrera and musician and composer Joseph Clayton Mills, an original contemporary dance piece that interrogates questions of the body in surgery, so that we may have both sides of the medical relationship in dialogue in the same space. The contradictions of delicacy and strength, modesty and suffering, body and mind. Which is all to say—this is just the beginning.
How Human Nature dotes
On what it can’t detect
Our slight figure had passed
through the inner door and left
it ajar for early others to follow
Carrie Olivia Adams is the Museum’s Spring 2017 Artist in Residence. She is the author of “Operating Theater” (Noctuary Press 2015), “Forty-One Jane Doe’s” (book and companion DVD, Ahsahta 2013), and “Intervening Absence” (Ahsahta 2009) as well as the chapbooks “Grapple” (above/ground press 2017), “Overture in the Key of F” (above/ground press 2013), and “A Useless Window” (Black Ocean 2006).