About a year ago I co-hosted a baby shower for two friends, one of whom teaches history with me. To guard their privacy, I will rename the couple Leo and Julia Sterling, partly based on yesterday’s and today’s names of the day at BehindtheName.com, one of my favorite character development tools. The fake surname came from a new tool that I will have to add to my list: the name generator.
Read more about why cocaine for surgery and heroin from the Sears Catalog was actually a step up for the history of medicine.
Victorian childbirth and child-rearing: A Toast
In the division of labor that produced this shower, my fellow co-hosts chose me to say a few words because of my extensive experience in childbirth and child-rearing. [Ahem, no.]
I thought that I would start with a language Leo and I both understand: history. I sought advice from Victorian England, which as we all know is really the apex of inclusivity, equality, and morality. [More laughter because, yes, this is ridiculously untrue.]
I first took a look through Letters to a Mother, on the Management of Herself and her Children in Health and Disease, Embracing the Subjects of Pregnancy, Childbirth, Nursing, Food, Exercise, Bathing, Clothing, etc. etc. with Remarks on Chloroform. The chloroform was for the mother, not the child, to help her remain “in a state of quiet, placid slumber” throughout birth, just like Queen Victoria. That sounds awesome. Dangerous, maybe, but awesome. [Edited later: According to her physician, “The chloroform was not at any time carried to the extent of quite removing consciousness.” So less dangerous, but probably still awesome.]
Various bottles of chloroform dating from 1801 to 1910, courtesy of Wellcome Images at Wikimedia Commons.
This book also warns us not to make the baby’s room in the basement of the house, so—Leo? Julia?—I think we’re good there. In other research, the Boston Medical Journal does warn of the “intemperate use of fruit,” and I am not sure what to tell you to do with that piece of information.
Master Baby by Sir William Quiller Orchardson, painted in 1886 and now housed in the Scottish National Gallery. Digital image courtesy of Wikimedia Commons.
Woman’s Worth; or, Hints to Raise the Female Character is maybe a better fit for us, especially for Julia’s interests. It seems to know of her love of “the blandishments of the theatre [and] the excitements of the dance,” and it mentions the option of committing “the charge of her child to dependents and servants” so that she preserve time for all her interests. This sounds good to me, as well; but in the same pages, the book advises that a parent’s influence is essential in the child’s character development. For no matter the “attractiveness of children, there are in those young hearts the seeds of evil,” including “dark deformity, headstrong passions, and vicious thoughts.” I think all of the educators in this room are nodding their heads.
Is proper education the answer, you wonder? The Rearing and Training of Children cautions that reading “is generally begun too early,” so maybe you will just have to throw away all those children’s books you’ve received, including the ones from us.
The manual continues: “As for committing prose or verse to memory, the practice, good enough in some respects, is much abused. Children will remember what they know and feel interested in, and knowledge should come to them easily, sweetly, and naturally.” Leo, I think your students would like you to pay particular attention to this point. There is “no necessity for any part of education being made irksome.”
Tell that to this American Thomasite, Mary Scott Cole, who is pictured with her class in Palo, Leyte. Photo from the University of Michigan Bentley History Library.
But, frankly, I don’t think any of these manuals are helpful to us. History has failed me. What else can I draw upon? Well, I have raised three dogs from puppies, and I treat them all like my children. In that case, I cannot stress enough the importance of crate-training. The general rule of thumb is that your new furry bundle of joy can be left in his crate about an hour at a time for each month of age. Also, freeze-dried liver and pigs’ ears are particularly effective training treats and sure to be your baby’s favorite, especially if we are to avoid that nefarious fruit.
Wait, has none of this been helpful?
Okay, well then let me say what we all know: Baby Sterling will be raised by two amazing parents. It has won the womb lottery. There is a reason that so many of us are here, that we seek Julia and Leo out in the Dining Hall or at faculty functions (and, yes, Leo, it is not just Julia we look for but you too). We are honored to be by your side as you start this new stage of your life. Know that there are many people in this room from whom you can seek support, comfort, and company. I just wouldn’t recommend asking your department head for advice.
Bottles of Chloroform photographed and shared in the Creative Commons by Kevin King, via Wikimedia Commons.
Caton, Donald. What a Blessing She Had Chloroform: The Medical and Social Response to the Pain of Childbirth from 1800 to the Present. New Haven,
Conn.: Yale University Press, 1999. EBSCO eBook Collection (53042).
Conquest, J. T., M.D., F.L.S. Letters to a Mother, on the Management of Herself and her Children in Health and Disease, Embracing the Subjects of Pregnancy, Childbirth, Nursing, Food, Exercise, Bathing, Clothing, etc. etc. with Remarks on Chloroform. London: Longman and Co., 1848. Accessed September 15, 2019. http://books.google.com/books?id=ACdlAAAAcAAJ.
The Metropolitan Working Classes’ Association for the Betterment of Public Health. The Rearing and Training of Children. London: John Churchill, 1847. Accessed September 15, 2019. http://books.google.com/books?id=o_MDAAAAQAAJ.
My favorite stuffed animal as a child was a weird-looking turtle named Snoozie. My bedtime stories were mostly Snoozie skits—half-Muppet Show, half Lion King—as written and performed by my father. When my beloved Snoozie tore a seam, my father stitched him up. The surgeon of the house did all the sewing. My father also removed my splinters with the tip of an eight-inch butcher’s knife. Since I could not stand to look at the knife, I watched his face as he concentrated. He never missed one, and it never hurt.
As I grew older, I loved to hear tales of my father’s training in medical school, like when he had to draw his own blood because his partner had passed out. He filled the syringe and handed it over when the other guy woke up. Another classmate devoted only one line in his notebook to each day’s lecture. Later, if anyone had a question about what was said a month ago in physiology, this fellow would look up the right dated line and reprise the professor’s entire hour-long talk verbatim, even the bad jokes.
Despite this steady diet of stories, my father did not believe in pressuring his only child to follow in his footsteps—not that it was much of a choice for me after college. I am a bit embarrassed to admit that I did not take a single laboratory science course after high school, and that omission would have been a problem on my application—in the 1990s. In the 1890s, not so much. Harvard Medical School accepted nearly all applicants. Well, all male applicants. The president of the university considered coeducation “a thoroughly wrong idea which is rapidly disappearing.”
Sugar Communion’s heroine, Dr. Elizabeth “Liddy” Shepherd, as inspired by an 1896 fashion plate at the Met. (She will borrow the dress.)
Fortunately, coeducation did not disappear and, also fortunately, other medical schools at the time did accept women, including Ohio Medical University, where my next heroine, Liddy, will be trained. She will be one of about three women in her class of forty-nine. (My father went there too. By the 1960s, it was known as the Ohio State University College of Medicine. Go Bucks!)
Ohio Medical University was one of the predecessor institutions of the eventual Ohio State University Medical School, and the affiliated Protestant Hospital would eventually become Riverside Methodist Hospital. This original campus was at Goodale Park. Postcard courtesy of Historical Reflections, the Ohio State Medical Heritage Center Blog.
Liddy will be unusual because she will have a bachelor’s degree when she starts medical school—something only eight percent of American medical students had in 1894, when she began. Typically those eight percent probably came from the bottom of their respective college classes. Scholars with promise went into teaching or the clergy. Physicians were considered “coarse and uncultivated . . . devoid of intellectual interests.” There was a real danger that too much science would “overcrowd” their limited minds. There were no written examinations at Harvard Medical School. None. In fact, that would have been impossible, one professor complained, because half of his students “could barely write.” He was not making a joke about doctors’ poor penmanship.
How could this be?
The Humoral System (Pre-Gilded Age)
Let’s talk first about what we know about what makes us sick. For far too long—from the ancient Greeks to the middle of the Victorian age—the European system of medicine described the human body as a balance of four substances called humors. If you had too much blood, the first of the four, it made you sanguine—courageous, hopeful, even amorous. Too much yellow bile turned you choleric, or hot-tempered. Black bile produced melancholic scholars, Shakespeare’s favorite. Too much phlegm slowed you down, made you apathetic. Your “sense of humor,” as it was known, even dictated which internal organs were most likely to fail you, like a combined CT-scan-slash-Meyers-Briggs personality test.
Blood was the only humor that could be spilled on command, so bleeding became a popular treatment for any imbalance. If you were sick in the eighteenth century, you headed off to your neighborhood barber-surgeon, maybe get a few teeth pulled while you were there. In 1793, when Founding Father Dr. Benjamin Rush faced a yellow fever epidemic in Philadelphia—then the nation’s capital—he treated one hundred people a day by draining two liters of blood per person. That’s about forty percent of the blood in their bodies! Half of Rush’s patients died. When George Washington fell ill from a throat infection in 1799, he was bled the same amount by his doctor. He died. Washington’s physician, like Rush before him, and like the barber-surgeons before them, used a specific scalpel named after a medieval weapon. It was called a “little lance,” or a lancet. A publication named The Lancet was and still is a leading medical journal. That’s like naming an education blog The Paddle.
“Leeches, a type of worm with suckers at both ends of the body, were used in bloodletting. It was the job of the leech finders, usually women, to collect these creatures for medical use. The leeches attached themselves to the legs and feet of the women who plucked them off and stored them in the little barrels of water. Doctors grew rich at the expense of these low paid women. Leeches were such a popular treatment that by 1830 demand outstripped supply all over Europe. Today, leeches are used following plastic and reconstructive surgery as they help restore blood flow and circulation. The print appeared in Costume of Yorkshire, published by George Walker in 1814.” Image and caption from the Science Museum Group.
Less extreme than the lancet were leeches, or parasitic worms. At the beginning of the nineteenth century, Britain imported 42 million leeches a year, seven million for London alone. That was about three leeches per person, but it still wasn’t enough. One British doctor admitted to using the same leeches on fifty different patients in succession—not realizing that he was exposing that fiftieth patient to blood-borne diseases from the last forty-nine people he treated. No wonder Napoleon called medicine “the science of murderers.”
He should know. He had been given another favorite prescription of the age: calomel, or mercurous chloride, which was prescribed as a magical tonic for almost any ailment, from tuberculosis to ingrown toenails. It was another humoralist treatment: if you did not want to drain blood, you might choose purge your patient from both ends with powdered mercury. Among the many, many symptoms of mercury poisoning are tremors, loss of teeth, and amnesia. Oh, and death.
No, I’m not blowing smoke up your ass. Wait, did you ever wonder why we say such a thing? The biggest fear of the eighteenth and nineteenth centuries was, shockingly, not doctors themselves but their doctors burying them alive. George Washington’s last words were instructions not to conduct any funeral for three days, just in case his physicians were not capable of distinguishing between life and death. Apparently, he had not heard of the latest sure-fire test, a tobacco smoke enema. Blowing smoke through a tube into a person’s nether region was sure to animate any phlegmatic—even before Dr. Previnaire added a bellows, a hand-held blower like I use in my fireplace, to create his patented anal tobacco furnace. The Academy of Sciences in Brussels gave Dr. Previnaire a prize for his work (Bondeson 139).
Resuscitation Set from the first half of the 19th century, courtesy of the Science Museum Group.
This is not medicine, you say; it’s snake oil! Absolutely, another popular remedy.
There were some bright spots. British Naval surgeon Dr. James Lind discovered that oranges and lemons helped his sailors recover from scurvy, but he did not know why. He did not even know what Vitamin C was. Still locked into a humoralist mindset, he believed scurvy was caused by cold, wet sea air and a lack of exercise. And, yes, vaccination did exist at this time—in fact, a form of vaccination has been around for a thousand years—but originally no one could explain how it worked.
It was not until the population medicine studies of Pierre Louis in 1820s and 1830s France that people looked at the data and said maybe bleeding doesn’t work. Louis introduced a new way of examining the efficacy of treatment: looking at large numbers of similar patients and studying their reactions to different applications of medicine. It was the first baby step toward clinical trials, though it was not yet randomized and his sample sizes were not very large.
Bloodletting faded from life slower than the patients who were being bled. Despite a very public debate between doctors in the 1850s, the practice persisted in textbooks as late as 1942. One part of the appeal may have been its accessibility and affordability. There were bloodletters everywhere, and they were cheap “health care.”
Another reason it persisted: no one had yet proven another theory of disease. All the pieces were there. Contagion was not a new concept: even as far back as the Islamic scholar Ibn Sina, there was an idea that disease could be spread by touch. Animalcules, or microscopic organisms had been seen as early as the 1670s. Dr. John Snow (not that Jon Snow) had shown it was not miasma, noxious urban gasses, that caused cholera but something the sick had passed to the water through their feces. Snow did not make this discovery with a microscope, though, but with a map showing clusters of cases around certain well pumps.
Snow’s map of cholera deaths in the Broad Street area, courtesy of the Department of Epidemiology, at the University of California Los Angeles School of Public Health.
But Snow did not really change long-term thinking. The handle was reinstalled on the Broad Street pump in London a couple of weeks later, after the cholera crisis had passed. Maybe, they thought, Snow did not really know what he was talking about. Mysterious waterborne poison, indeed.
Gilded Age Medicine
You cannot change the answers until you change the questions. And you cannot change the questions until you admit what you don’t know. What was in the air—or water—that we were not seeing? At the beginning of the Gilded Age, Louis Pasteur introduced an anthrax vaccine in 1881 and a rabies vaccine in 1885. Pasteur’s best frenemy, German physician Robert Koch, isolated the bacterium that causes tuberculosis in 1882. In 1884, he did the same for cholera. These were four of the worst disease bogeymen of the modern age. Modern bacteriology and immunology were born.
Once the bacteriology-immunology ball got rolling, lots of diseases were ready to be prevented. This chart of the history of major vaccine development is from Bioinformatics for Vaccinology by Darren R. Flowers.
By the way, the man who introduced these two rivals, Koch and Pasteur, was Dr. Joseph Lister, the first surgeon to disinfect wounds and sterilize surgical equipment. You know his name as the root of the brand name Listerine. Yes, you are rinsing your mouth with surgical antiseptic. Please continue to do so.
It would take time before the best and brightest of the American college set would pursue a career in medicine. And, like my character Liddy, if you wanted the best post-graduate education, you really had to go to Europe. While earlier in the century that may have meant Edinburgh or Paris, by 1890 that meant Germany or Austria, and in particular the Allgemeines Krankenhaus (General Hospital) of Vienna. (And you ate dinner at the Riedhof too!)
Wien Wickenburggasse mit Riedhof, outside the Vienna General Hospital. Photo from vintage postcard.
Back in the US, it was not until 1910 that medical education truly changed. Two of the richest men to ever live, John D. Rockefeller and Andrew Carnegie, funded the Flexner Report, which was like an early US News & World Report ranking guide to medical schools—and like all of those publications, it was deeply flawed. The publication of the Flexner Report in 1910 is credited with creating the modern scientific medical school system in the US, but it also directly or indirectly caused the closure of many medical schools for women and African Americans. Those that had been coeducational reduced their admission of women, partly because they had a rise in male applicants. One study calls an unintended consequence of Flexner’s report “the near elimination of women in the physician workforce between 1910 and 1970.”
The General Hospital of Vienna, a favorite place for post-graduate study for American medical students in the late 1800s. Illustration from Wikimedia Commons.
Nevertheless, the Gilded Age must have been very exciting to live through. Every day, it would seem, more diseases were being identified and explained. Notice that I did not say cured. Calomel was still popular in the early 1880s, as were chocolate-covered arsenic tablets. Aspirin existed, but no one knew how it worked until 1971! Cannabis was legal until the xenophobic backlash against refugees fleeing unrest south of the border after the 1910 Mexican Revolution, and then this effective pain reliever was demonized.
Who won the 2016 election? Marijuana, of course. But beware! Gilded Age America preferred cocaine tooth drops. Find out more.
There still was no real anesthesia for surgery except ether and cocaine. Cocaine was quite handy, actually, and it was sold in lozenge form for toothaches. Bayer Pharmaceuticals introduced a new form of cough relief that they said was just as good as morphine, but not as habit-forming. They trademarked this miracle compound: Heroin. You could buy two vials for $1.50 from Sears, complete with carrying case and dosage instructions for children!
Heroin advertisement from p. 377 the November 1899 issue of the New York Lancet, accessed at Wikipedia Commons.
Paul Ehrlich was playing around with dye stains when he stumbled upon the inspiration for a chemotherapy treatment for syphilis that would eventually be known as Salvarsan. He and his assistant, Sahachirō Hata, introduced their “magic bullet” to the world in 1909. It was an actual medicine with laboratory-tested results, and really the importance of this fact cannot be overstated. There was no other treatment for syphilis at this time. (And masturbation was discouraged in the strongest moral terms. See more on syphilis in historical romance—or, really, the lack of it.) The administration of Salvarsan was technically complicated and cumbersome, though, and the disease had to be caught in time. Ehrlich had wanted to discover a “magic bullet” for what ailed us, but nothing was that simple. Eventually, post-Gilded Age, sulfa drugs were introduced (1930s) and penicillin and other antibiotics shortly thereafter, but old habits of calomel and bloodletting died harder than they should have.
Modern Parallels
Opioid addiction rates are not the only modern parallels to Gilded Age medicine. We still distribute poisons that would make the merchants of mercury blush. For example, botulism bacteria produce a paralyzing substance so toxic that one teaspoon could kill as many as a million people. You know it as Botox, a medically recognized treatment for Cerebral Palsy and chronic migraines. Or you might have it injected into your face to smooth your wrinkles. No judgment.
Progress is not always a straight line. Leeches and maggots are making a comeback—raised in sterile conditions, fortunately, and shipped to an intensive care unit near you. The leech releases an enzyme that keeps blood vessels open, which is essential in reattachment surgery particularly in fingers and toes. Maggots are good for recurring ulcers of the skin caused by drug-resistant infections like MRSA. Maggots only eat dead tissue—as long as you get the right type—and also release an enzyme that promotes healing. And even bloodletting, or phlebotomy therapy, may be used today for specific diseases of overproduction of red and white blood cells and excess iron.
The medicine of World War I is also making a comeback. Bacteriophages are viruses that destroy bacteria. Honestly, they look like creepy spiders from a horror movie. They are hard to keep alive in transport—which is why they were tossed aside when antibiotics were discovered—but in an era of resistant superbugs, they may be the answer.
Microscopic images of nanostructural and biological bacteriophages, courtesy of Wikipedia Commons.
My father is now retired from stitching up humans and stuffed animals. There are many talented, highly-trained, and impressive women and men who have taken his place. This Thanksgiving I am grateful for them all, from emergency room nurses to the scientists behind messenger RNA vaccine development. But if this somewhat sordid tour of medical history has taught us anything, it is this: whether you are doctor or patient, teacher or student, we need to keep in mind the wise words of 12th-century rabbi, scientist, and physician Maimonides: “Teach thy tongue to say ‘I do not know,’ and thou shalt progress.”
Even Maimonides should have trained his tongue better. After all, he believed in bloodletting.
Further Reading
Want to know more about the history of medicine? I used a collection of podcasts introduced in my previous post, and I cannot recommend them highly enough! For more on sex education manuals of the time, check out my random sampling.
More Medical Advertisements from the gilded age
I just could not help including this. It is the Allison “operating” table, as advertised on page 352 in the New York Lancet. Maybe they’re going to try the tobacco smoke enema?Bisedia advertisement from a 1908 edition of the Lancet. The compound included bismuth, “Pepsina liquida” (“a palatable, standardized solution of gastric juice from the pig”), morphine hydrochloride, hydrocyanic acid, and tincture of nux vomica (strychnine). Yikes, please don’t take this.Want more heroin? This advertisement was in the 1908 volume of The Lancet. Notice the dosing for children.Cocaine drops, anyone? This advertisement is from the 1908 Lancet.Yet more heroin advertisements from the 1908 Lancet.I got nothing. Also from the 1908 Lancet.
In addition to an extensive list of memoirs, biographies, and research texts on medical history that I have read for background research on Sugar Communion, I have also spent a lot of time walking the dog and listening to podcasts. Here’s a photo of Wile E. and me on the way to the trail, just because:
Heading out to the trail and hoping we’re the only ones on it. Listening to medical podcasts during COVID is on-point.
My heroine, Dr. Elizabeth “Liddy” Shepherd, M.D., is one of many young women who became physicians or surgeons at the turn of the twentieth century. Many? Yeah! I mean, not a flood but enough to say that it was a viable career path for quite a few. In romance novels, the introduction of a female doctor character is often presented as something truly exceptional: “the only female physician in England,” one says, which is sorta lousy history. (Is it good marketing? I suppose so.) The aforementioned heroine was loosely based on the first female physician licensed in England, Elizabeth Garrett Anderson—not counting James Barry, who was assigned female at birth. By 1876, the year this other novel takes place, Dr. Anderson was already training female doctors by the class-full in the medical school she had opened—women who could have applied for licensure just like hers. Also, Scotland not England was really the “scene of the first major attempt by British women to break into the exclusively male world of medicine.”
Check out my Pinterest pages for all my inspirations and visual research. Liddy will grow up in a medical family: her father and two brothers are both physicians of the eclectic school and operate a hydrotherapy sanitarium (think Kellogg‘s Battle Creek sanitarium for more frugal customers). She will go against her family’s wishes—not in becoming a doctor but in studying the new microbiological, laboratory-based field, which they regarded as a threat.
Women in the US probably had an easier road, with several coeducational and women’s medical schools existing in the Gilded Age, especially in the midwest. At the University of Michigan, for example, women made up a quarter of the class. The school turned out country doctors—a difficult, smelly career that these Gibson girls were welcome to try. Michigan was a better school than most, but in general medical education was not really stellar for either men or women. For example, there were no written examinations at Harvard Medical School at the beginning of the Gilded Age. None. In fact, that would have been impossible, one professor complained, because half of his students “could barely write.”
Ohio Medical University was one of the predecessor institutions of the eventual Ohio State University Medical School, and the affiliated Protestant Hospital would eventually become Riverside Methodist Hospital. This original campus was at Goodale Park. Postcard courtesy of Historical Reflections, the Ohio State Medical Heritage Center Blog.
It was the improvement in the status of doctors that led conservative elements of American society to decide that medicine was not an appropriate career for women, often because a woman doctor would be taking a “good job” from a man. The publication of the Flexner Report in 1910 is credited with creating the modern scientific medical school system in the US, but it also directly or indirectly caused the closure of many medical schools for women and African Americans. Those that had been coeducational reduced their admission of women, partly because they had a rise in male applicants. One study calls an unintended consequence of Flexner’s report “the near elimination of women in the physician workforce between 1910 and 1970.” It is the post-Gilded Age lack of women in medicine that makes us think that women have always been uniformly shut out of the field.
Sugar Communion’s heroine, Dr. Elizabeth “Liddy” Shepherd, as inspired by an 1896 fashion plate at the Met. (She will borrow the dress.)
(Side note: Johns Hopkins, the model of a modern medical school for Mr. Flexner, only managed to operate because of the patronage of four women: Martha Carey Thomas, Mary Elizabeth Garrett, Elizabeth King, and Mary Gwinn. According to Johns Hopkins: “They would raise the $500,000 needed to open the school and pay for a medical school building, but only if the school would open its doors to qualified women. Reluctantly, the men agreed.” Unfortunately, the legendary founder of internal medicine at Hopkins, Dr. William Osler, was less enthusiastic about the role of women in the field, and the numbers of female students would dwindle before growing again decades later.)
My character Liddy needs to be a good doctor, yet one appropriate to her time period. I had to understand the world of medicine she was a part of. Better than studying it, I had to immerse myself in it. For that task, I did use some good books, but mostly I listened to podcasts. Let’s talk about a few of those:
Bedside Rounds
I happened upon Bedside Roundsfirst and have since listened to every single episode. Dr. Adam Rodman is engaging and informative—so informative, in fact, that members of the American College of Physicians can earn Continuing Medical Education (CME) and Maintenance of Certification (MOC) credit for just listening to these episodes and taking a quick quiz! But, trust me, we general listeners need not worry about the test, nor are we left behind. Dr. Rodman’s intention was to model his podcast on Radio Lab, and his delivery is just as compelling and digestible (health-related pun?) as that popular program. There were times when I did backtrack 15 seconds or so just to let some point wash over me a second time, but keep in mind that I was taking mental notes for my book. A casual listener can easily stay on pace, though Rodman doesn’t shy away from the tough stuff. His presentations do have lighter moments but never get silly. Listening changes the way you view medicine, mostly by making you realize how young the field really is. (Note: The COVID-related episodes, including an in-depth treatment of previous coronaviruses and the 1918 flu, are very good.)
This podcast will kill you
Two immediate advantages of This Podcast Will Kill You are (1) the incredibly impressive epidemiologist-and-disease-ecologist-presenter-duo, Erin Welsh, Ph.D. and Erin Allmann Updyk, Ph.D.; and (2) the structure of each episode into separate segments on biology, history, and modern epidemiological issues related to each chosen disease. (They also have a Quarantini—or, if you prefer, a non-alcoholic Placeborita—for each episode, and this was before we were all quarantining.) “The Erins” (their label, though I prefer “Dr. Erins”) have just begun their fourth season, and that is a lot of episodes to catch up on, but you will be glad you did. Until I listened to TPWKY, I did not truly understand sickle cell disease, for example, or dengue—not even while I lived in the Philippines, which is embarrassing.
The Dr. Erins deal with diseases that other podcasts do not cover, like rinderpest, the bovine form of measles, which will have to be another glossary post on this blog because it comes up a few times in my books. (The Philippines lost 90% of their carabao population during the Philippine-American War period, which added greatly to the suffering of the people.) TPWKY also has episodes on cholera, malaria, and other diseases that have made an appearance in Under the Sugar Sun and, in particular, Tempting Hymn. Upcoming in Sugar Communion, TPWKY has been instrumental in my understanding of syphilis (don’t worry, I will stick to the chronotope), as well as smallpox and the history behind vaccines, aspirin, and caffeine. Relevant to the whole nineteenth and early twentieth century periods, there are episodes on typhoid fever and yellow fever and so much more! The more I listen, the more I love this podcast. I think they are having lots of (appropriate) fun too.
(Note: TPWKY also put out a series of excellent COVID episodes, as you might expect. They are broken down by different facets of the pandemic, along with a December 2020 update.)
the history of medicine
I have only listened to the first half of the first season of The History of Medicine podcast, but what I like about it is the deep dive into a narrative history of one big medical invention at a time. The first season is all about antibiotics—yay, penicillin! The show on plague (Yersinia pestis) is an excellent short backgrounder for all history teachers. A final advantage is that each episode here is very short. A possible disadvantage is that host and producer Kirby Gong is not a practicing physician—he only (ha!) has a master’s degree in biomedical engineering—but, actually, I call his perspective an advantage. He investigates medical inventions in a more procedural way. This podcast is the lens of an engineer, and I find that fascinating.
this won’t hurt a bit
This Won’t Hurt a Bit was a lot of fun, but sadly you will quickly run out of episodes. The two ER physicians who are the main hosts here, Dr. Mel Herbert and Dr. Jess Mason, are so busy with saving lives and producing other educational modules for ER docs that they are not actively creating many new releases. (Note: They do have a few COVID episodes that I have not gotten to yet. I am more interested in everything non-COVID right now. Go figure.) Though these doctors are not exclusively focused on history, usually each episode touches upon the historical approach to a disease or treatment in some way. They also teach you a lot about being a good patient, including when you might want to go to a hospital yourself! Dave Mason, Jess’s non-MD husband, is also one of the hosts, and he provides banter and asks the questions you really wanted to know. What I appreciate about Dave, though, is that he is not entirely silly, and he does not derail Mel and Jess when they are delivering information. This podcast is very well produced and engineered, with additional asides and definitions that you appreciate not dread.
sawbones
Sawbones is probably the most popular podcast of all the above, at least by the size of the live audiences that they have performed in front of (pre-quarantine days). This podcast is billed as “A Marital Tour of Misguided Medicine,” and that is because the show is based around the relationship of the medical host, Dr. Sydnee McElroy, and the comic relief, her husband Justin McElroy. (And they published a book too!) Most of the background medical history research is done by Sydnee—or maybe I’m underestimating Justin?—and fortunately she brings her A-game. Her episode on hydrotherapy was quite useful for my research. Dr. McElroy is also living and practicing in Huntington, W.V., which is where my grandparents and aunt lived (and therefore I spent a lot of time growing up)—and I feel connected to the McElroys that way too. (Surprise, surprise, they have several COVID episodes that I have not listened to yet, and they have also done an important set of podcasts on the history of medical racism inspired by recent protests.)
[Edited to add: The most recent episode on “Physician Burnout” is essential listening for all of us, physicians and patients alike. If you work in another “helper” profession, there are many parallels you will relate to.]
[just added!] maintenance phase
Maintenance Phase, a podcast that bills itself as “Wellness & weight loss, debunked & decoded,” started as a friend’s recommendation. She suggested the “Olestra” episode because I have family members who were involved in that indigestible chapter of history. This show has quickly become one of my favorites for general listening, though. I am one of those people who have been constantly in one diet cult or another my whole life, and counterprogramming is a challenge. The hosts of this podcast are not just scientifically informed, they are so much fun to listen to. In terms of medical history, their “Snake Oil” episode is one of my absolute favorites.
[just added!] the curious clinicians
The Curious Clinicians is sometimes too much for me, the writer who had not taken biology since freshman year in high school. This podcast is hosted by doctors and lab researchers for a similar audience, and so they do not explain every term or concept for the non-biologists in the room, and I recommend that we humanities folk out here choose our episodes wisely—but not shy away altogether. One episode that is amazing for everyone, especially if you are a foodie, is: “Episode 9: Why is umami so delicious?” A runner-up is “Episode 4: Why did Van Gogh paint with so much yellow?” Currently, I am learning about how fevers are actually useful, which is why almost all animals and even plants use them to fight infections!
stuff you missed in history class
For a history podcast, Stuff You Missed in History Class touches on medical topics a lot. There is even a good episode on the Flexner report, mentioned above. I think this is because the hosts, Holly Frey and Tracy Wilson, show a real concern for the daily lives of past people. One of their other stand-out episodes for me was on the “Orphan Trains,” which is a footnote of history you might also see in Sugar Communion. [Update: I don’t know anymore. I have to do a lot of cutting.] There is a deep backlog that I plan to dive into once I’m finished with some of my medical questions.
the others you see on my player
There are more podcasts that I have not yet gotten around to, like the History Chicks, the Revisionist History podcast, and This Land. Other titles are related to my professional interests. I highly, highly recommend the first season of Blowbackabout the Iraq War. I do not think that I can say that enough times. There are other podcasts in my favorites that I have listened only to a few episodes of, like Casenotes. (Nope, not the true-crime podcast, but the medical history one. It is a fortnightly podcast from the Physicians’ Gallery at the Royal College of Physicians of Edinburgh. Essentially it is just the audio of lectures given by doctors and epidemiologists for other highly-degreed people. It can be very good, depending on the speaker, but it is like listening to a conference, not a highly-produced podcast.)
You may have also noticed Book Thingo on my Stitcher account because it’s the best romance podcast out there, and I’m not just saying that because they were willing to talk to me. Kat Mayo is also the originator of the #UndressAndres hashtag, so I owe her a lot. [Edited to add: Did you know I was interviewed for a podcast on Balangiga too? Check it out!]
If you know of more stuff I should be listening to—especially anything relevant to Sugar Communion—please let me know. My dog always needs walking.
Did doctors of the day believe in “virginity tests”?
Did they understand a woman’s body and how to bring it pleasure?
Did they think that sex should be pleasurable for women in the first place?
Finally, how did they feel about masturbation, or self-pleasure?
In my unscientific, random sampling of (cishet) primary sources, the Gilded Age scored 2.5 out of 4, which was a little better than I anticipated. (That’s a surprise, considering the general state of medicine until at least the 1880s.) Let’s investigate:
“Virginity tests”:
The hymen does not start whole—a perforation is needed to allow menstrual fluid to escape, after all—but a woman can easily tear and rub away the rest through an active lifestyle. Horseback riding, yes. Sneezing? Eh, probably not. But it was nice that Dr. Foote erred in her favor. It is also nice that he acknowledged that the hymen test was “cruel and unusual.”
However, it is depressing to also note that, due to “popular prejudice,” even the best physicians concealed the whole hymen truth. This led some fearful young women to try to “tighten” their vagina with alum, something I found discussed in a magazine of 1880 erotica (written by and for men). The alum suggestion wasn’t new—women had been encouraged to try this since medieval times—but it didn’t work then, and it still doesn’t. It just dries you out. There is no virginity test other than asking a person.
a woman’s body:
This may be the Gilded Age quote that surprised me the most. I had thought for sure that today’s popular culture would be more knowledgeable than 150 years ago, especially regarding the clitoris, but no! In fact, did you know that even in the eighteenth century, the most widely printed medical book in Europe and America informed men about the clitoris? Yay, cliteracy!
A complete drawing from the 5th edition (1914) of Human Anatomy: A Complete Systematic Treatise by Henry Morris. This textbook, first published in 1893, was used by the American teachers in the Philippines in the early 1900s.
Fortunately, my heroine Allegra in Sugar Moon has a Gilded Age anatomy book (the one above) to guide her explorations. Every virgin should have one! Her hero, Ben, appreciates her sharing her new knowledge with him, too. This is why I love writing romance, a genre that prioritizes the needs, strengths, and happiness of women. Real romance doesn’t ignore the clitoris! I’m going to cross-stitch that on a pillow someday.
A woman’s pleasure:
Pleasure and procreation may coincide, but one is not required for the other—for women. Herein lies a problem with how we teach (or don’t teach) women about their bodies. Even today, students may be taught reproductive biology, but that curriculum illustrates a prudish bias: a woman’s anatomy is described like plumbing, with pipes only used for pumping out children. In this narrative, only the male’s sexual pleasure is required for procreation, leaving the impression that men are the only ones who experience desire (or who should experience it).1
How sex-positive were Gilded Age experts? Did they think women should receive pleasure from the act? Dr. Foote, author of the above quote about the clitoris, believed that all aspects of sexual interaction—from friendly conversation to full, pleasurable intercourse—were absolutely necessary for good health: “I place sexual starvation among the principal causes of derangements of the nervous and vascular systems,” he said.
Now let’s check in with a woman, “sexual outlaw” Ida Craddock, who was sent to jail for sending “obscene” sexual education materials through the mail (to subscribers).2 Craddock’s description of a woman taking an active part in intercourse, even to the point of describing specific motions, is refreshing. She also claims that these motions will improve a woman’s sexual passion, which is encouraging. But—and this is a big BUT—Craddock believes the woman’s passion is irrelevant. A fortunate by-product, yes, but unnecessary. Bummer.
In fact, Craddock believed so strongly that sex was for procreation that her vision of contraception was coitus without orgasm—for both partners—for the entire duration of pregnancy and two years following. She thought this sexual brinksmanship would make both partners stronger. Three years of deliberate sexual arousal without release? No wonder Anthony Comstock, self-appointed male protector of American postal virtue, had her thrown her in jail.3
Overall, I’ll give the Gilded Age half a point here, and that’s being generous.
self-pleasure:
Your own pleasure starts with you:
Rosa did not have a lot of experience—none very good, at least—but neither did Jonas, it seemed. And Rosa knew something he did not. She knew what she liked.
“Look,” she said. She parted her lower lips to reveal the ridge that gave her the most pleasure when she was alone.
Or was this too much? To admit such a dirty secret, especially to a man—had she not learned her lesson? When she had tried to show Archie, he had lectured her about sin and a woman’s shame. Now she risked her husband’s disapproval, too.
Jonas looked up. “Show me what you want,” he said.
If Rosa could do it, so could anyone in the Gilded Age, right? Well, maybe not. Masturbation has long been considered a sin in the Judeo-Christian tradition, ever since Onan spilled his seed on the ground (rather than give his brother’s widow an heir) and God smote him (Genesis 38:9-10). In many traditional sources, the act is called Onanism. Thus, we are back to the idea that sex is only for procreation, a mission that made sense for the small, struggling band of Hebrews trying to survive the rough-and-tumble world of the ancient Near East.
A more recent concern by the Catholic Church about masturbation is the idea that it draws away from the sexual relationship—a withholding of yourself from what should be the most intimate aspect of marriage. It is considered “radically self-centered.” While, yes, an addiction to masturbation may be unhealthy, the knowledge of one’s own body cannot help but lead to a better shared experience. A shocking idea, I know.
And it was shocking in the Gilded Age. Edwardian prophets took the above warnings and turned them into near paranoia. The same level-headed, seemingly enlightened Dr. Foote who criticized the hymen test, described the importance of the clitoris, and said sex was healthy—well, he had only dire warnings about masturbation in 1887: “Many a promising young man has lost his mind and wrecked his hopes by self-induced pleasures.” Another author agreed: “That solitary vice is one of the most common causes of insanity, is a fact too well established to need demonstration here.” (That logic is convenient: it’s so true that I don’t need to prove it. Hmm…)
Doctors also advocated drinking mercury and ordering heroin from Sears. Read more about the birth of scientific medicine at the turn of the century.
Dr. Jeffries (1985) listed more terrible symptoms of this vice: a slimy discharge from the urethra, a “wasting away” of the testicles, ringing in the ears, heat flashes, large spots under the eyes, nervous headache, giddiness, solitariness, gloominess, and the inability to look the doctor in the eye. Others added cancer (!), acne (yep, that old hogwash), and a craving for salt, pepper, spices, cinnamon, cloves, vinegar, mustard, and horseradish. That last one is a head-scratcher. So if you wanted to eat anything with flavor at all, that was a giveaway? I’m in trouble.
Dr. Jeffries’s unexplained (and unverified) diagram of what happens to semen after masturbation. Are you wondering how he obtained the first sample without masturbation? Me, too.
Speaking of food, did you know that Corn Flakes were invented in 1898 to keep you from masturbating? For real.4
The John Harvey Kellogg quoted above is the Kellogg of breakfast cereal fame. His obsession with sexual purity was so extreme that he never consummated his own marriage. He and his wife slept in separate bedrooms and adopted their children. By the way, who did Kellogg believe were the worst masturbatory offenders? Foreigners, of course. Russians especially. Add eye roll here.
The cure? Clean living! Rising early in the morning, eating the recommended bland breakfast, abstaining from smoke and drink, keeping busy, avoiding solitude, and circumcision. This is why the procedure became routine in American hospitals in the twentieth century and still predominates today. It is not good medicine but good morals. Or so they said. (There was not a lot of good medicine, especially at the beginning of the Gilded Age, but you had figured that out already, hadn’t you?)
Sugar Communion heroine, Liddy Shepherd, M.D., will grow up in a medical family: her father and two brothers are both physicians of the eclectic school and operate a hydrotherapy sanitarium (think Kellogg’s Battle Creek sanitarium for more frugal customers). She will go against her family’s wishes—not in becoming a doctor but in studying the new microbiological, laboratory-based field, which they regarded as a threat.
There is still a bit of taboo in talking about masturbation today—well, maybe more than a bit. In 1994 President Bill Clinton forced his Surgeon General Joycelyn Elders to resign because she said that masturbation should be taught in schools as a preventative for teenage pregnancy and sexually-transmitted diseases. Still, I think we are a far cry from saying it causes cancer. And we’ve sweetened breakfast cereals beyond recognition, so there, John Harvey Kellogg! More and more parents are questioning routine circumcision for non-religious reasons, though the procedure has traction because it is what people in the US are used to.
All this brings me to an interesting realization: if you asked me which parts of my books would have most shocked real Gilded Age readers, it would have been the openness most of my characters have toward masturbation. And, guess what? I’m not going to stop writing it, historical accuracy be damned. Long live romance!
Learn more about medical history from my favorite podcasts.
(Featured photograph is a close up of a Fallopian tube and ovarian ligaments in Henry Morris’s Human Anatomy: A Complete Systematic Treatise by English and American Authors, 5th edition, 1914, p. 1270.)
Footnotes:
1. What follows is a whole domino chain of bad decisions, including a teenage “hook up” culture that emphasizes sexual trophy hunting (most often by boys), rather than two people finding mutual pleasure in a mature relationship built on respect and trust.↩
2. The law against this distribution of “obscene” materials, the Comstock Law, is still on the books in a modified form. It no longer covers sexual education or contraception, the latter of which became a legally protected right—to married couples, originally—under the 1965 Supreme Court decision Griswold v Connecticut, also known as the Birth Control Revolution. Good thing, too, because this post would have gotten me jailed.↩
3. And she was not the only sexual rights crusader to have disturbing ideas. Marie Stopes believed in eugenics and forcible sterilization for those “unfit” to carry on their genes. She even “disinherit[ed] her son when he married a woman who had poor eyesight.” Yikes. And Planned Parenthood founder Margaret Sanger dabbled in eugenics, too, by the way. We need to question everything from this period because racism, classism, and ableism were pervasive.↩
4. The original purity food was the graham cracker, which was nothing like your s’mores building block of today. It was made of unrefined flour with no sugars or spices—deliberately bland. Because that contained sexual desire, didn’t you know?↩
At long last, an alphabetical listing of the Sugar Sun glossary terms. Simply click on the graphic of your choice to open the annotated post in a new window. This list will be updated to include new terms as their posts are written.
I hope the posts are helpful in rounding out the historical context of the Sugar Sun series. If you have any suggestions or comments, please contact me through one of the methods to the left of this page.
