Though not the height of fashion, a white cotton shirtwaist was the unofficial uniform of schoolteachers in the Edwardian Philippines. Having used a chalkboard for a good part of my own teaching career, I can attest that having your sleeves already be white is extremely practical. Two of my previous heroines, Georgina and Allegra, thought so too.
According to the Indianapolis Journal on January 1, 1900: “The shirtwaist will be with us more than ever this summer. Women are wearing shirtwaists because they are comfortable, because they can be made to fit any form, and because they are mannish.” Fashion historian Catherine Gourley explains that “it was similar to a man’s shirt. It had a stiff, high-necked collar and buttons down the front. Women often wore one with a floppy bow or tie. Some pinned a brooch to the collar.”
In contrast, high fashion in the first decade of the 1900s was a structured Gibson Girl silhouette that looked a lot like that of the previous century, particularly the painfully small waist. The badly named “health” corset “pushed the bust forward and the hips back in an attempt to avoid pressure on the abdomen,” according to the timeline of the Fashion Institute of Technology (FIT) of the State University of New York. The shape was top-heavy with dramatic sleeves, “enhanced with petticoats that had full backs and smooth fronts” (FIT).
Dresses did not loosen until around 1910 or so, but fortunately Sugar Communion is quite epic in scope so I can explore new fashion templates that look far more comfortable. I was surprised by how 1920s-esque they looked, and then I found that FIT agreed with me: “While changes in women’s fashion that manifested in the 1920s are often attributed to changes due to World War I, many of the popular styles of the twenties actually evolved from styles popular before the war and as early as the beginning of the decade.”
I paged through only a few of the plates at the Costume Institute Collections at The Met to get an idea of what I would like to see Liddy wear, when she gets the chance—when she is not tending to patients in a practical shirtwaist, that is.
I think the geometric patterns on the above skirt would appeal, though Liddy is not likely to be seen at entertainments like horse races, nor would she approve, probably.
See what I mean by the roaring twenties vibe? Ignore the hat on the right, which seems to be an inspiration for Dr. Seuss’s cat. Both of these dresses seem so elegant. The one on the left I can see Miss Fisher wearing while she solves a murder mystery.
I do not understand the knotted kerchief hanging off the belt on the right illustration above, but that blouse and skirt is otherwise very modern. Also, women began to dare to show some ankle—racy, I know!—though not bare skin. My heroine Liddy does not have the time nor inclination for hose, so socks and boots are her daily wear.
I think that back in the 1980s I had a blouse like the one above on the left. No feathered hats for me or Liddy, though.
These plates tell me that clothing was starting to become more comfortable, and even high fashion followers did not want to be dependent on a maid to dress them all the time.
Can you imagine having a ladies’ valet in 2020? “The yoga pants again, ma’am?”
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.
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.]
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.
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.”
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.
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.
In November of 1899 the Philippine-American War shifted into a long stage of protracted guerrilla warfare. Outnumbered by the uniformed Filipino revolutionaries by more than three to one, and with white volunteer regiments rotating home at the end of their year-long enlistments, the War Department transferred 6000 African American soldiers to the Philippines (Russell 2014, 205). This included the 24th and 25th Infantries to the Philippines, as well as two newly-formed regiments (the 48th and 49th US Volunteer Infantries), and both the 9th and 10th Cavalries (New York State Division).
There was good reason to call upon them: many of these men had achieved the highest military honors in the land due to their courage and valor under fire. The new arrivals “built and maintained telegraph lines, constantly performed patrol and scouting duties, provided protection for work crews constructing roads, escorted supply trains, and located and destroyed insurgent ordnance and other supplies” (Russell 2014, 205-6). But there would be a cost for doing their jobs too well. Sergeant Major John W. Calloway, experienced soldier and reporter for the Richmond Planet, called out the incongruency between empire and democracy—in private correspondence—and he was punished for it.
relations with the Filipino public
In November 1899, while the 25th Infantry was operating in the north of the country, they planned the raid of an enemy stronghold. In a war where “marked severities” were common enough among white units to warrant a later Senate investigation, the 25th kept their discipline. “In an instance of impressive restraint, these African American soldiers refused to massacre the unprepared and unorganized Filipino troops; instead they took over a hundred prisoners and captured stores of food, ammunition, and weapons” (Russell 2014, 205-6).
Filipino citizens immediately noticed the difference. As Filipino physician Torderica Santos told Sgt. Maj. Calloway:
Of course, at first we were a little shy of you [Black soldiers], after being told [by the whites] of the difference between you and them; but we studied you, as results were shown. Between you and him, we look upon you as the angel and him the devil. Of course you both are American, and conditions between us are constrained, and neither can be our friends in the sense of friendship; but the affinity of complexion between you and me tells, and you execute your duty so much more kindly and manly in dealing with us. We can not help but appreciate the difference between you and the whites (“Voices from the Philippines” 1899, 1).
In the article in the Planet, Calloway explains what passes as treating Filipinos kindly, at least by American Army standards: not spitting at them in the streets or calling them racial epithets (“Voices from the Philippines” 1899, 1).
Because of this relatively sympathetic treatment, some Filipinos were eager to have all American officials in their country be African Americans. “I wish you would say to your young men that we want Occidental ideas, but we want them taught to us by colored people. . . . We ask your educated, practical men to come and teach us them,” said wealthy planter Tomas Consunji, from San Fernando, Pampanga, north of Manila (“Voices from the Philippines,” 1).
Calloway agreed. He finished the article thus:
I wish to add before closing, that if our young men who are practical scientific agriculturalists, architects, mechanical, electrical and mining engineers, business men, professors and students of the sciences and who know how to establish and manage banks, mercantile business, large plantations, sugar growing, developing and refining, they will find this the most inviting field under the American flag. Cuba does not compare with the Philippines. Another thing too when they secure missionaries and teachers for the schools here, see that they get on the list. They must be represented there. . . . They extend to us a welcome hand, full with opportunities. Will we accept it? (“Voices from the Philippines,” 1).
Notice that in Calloway’s printed work, he agreed with the Progressives in their nation-building programs of “benevolent assimilation.” At least, he supported programs that provided opportunities for carpetbaggers of every race. A letter by Captain F. H. Crumbley of the 48th Volunteers printed in the Savannah Tribune agreed: “There are every openings here for the Negro in business, and room for thousands of them” (Ngozi-Brown 1997, 49).
Many Black soldiers did stay behind in the Philippines, according to another letter by Sergeant Major T. Clay Smith of the 24th Infantry in the Savannah Tribune: “ . . . several of our young men are now in business in the Philippines and are doing nicely, indeed, along such lines as express men, hotels and restaurants, numerous clerks in the civil government as well as in the division quartermaster’s office, and there are several school teachers, one lawyer, and one doctor of medicine” (Ngozi-Brown 1997, 49). Others became agricultural tycoons, judges, or small business owners (Ontal 2002, 129).
There was room for romance too. “Arguably, the Philippine islands had in its possession history’s largest proportion of African-American soldiers who opted not to return home after completing military service abroad” (Ngozi-Brown 1997, 51). Over a thousand of the soldiers deployed in the Philippines married Filipino women and stayed in the islands (Ngozi-Brown 1997, 50). In fact, Governor Taft admitted that he feared that these soldiers got along “too well with the native women,” and so he sent the rest of the Black regiments Stateside as quickly as possible (Ngozi-Brown 1997, 50).
too much democracy? Or not enough.
Got along too well? Exactly. In 1907 Stephen Bonsal, a Black correspondent in the Philippines wrote: “While white soldiers, unfortunately, got on badly with the natives, the black soldiers got on much too well. . . . the Negro soldiers were in closer sympathy with the aims of the native populations than they were with those of their white leaders and the policy of the United States” (quoted in Russell 2014, 213).
For example, Robert L. Campbell wrote to Booker T. Washington: “I believe these people are right and we are wrong and terribly wrong. I am in a position to keep from bearing arms against them and I will try and keep myself in such position until we are mustered out; of course, if I am ordered to fight, I will obey orders as a soldier should . . .” (quoted in Russell 2014, 212). But what if others did not obey orders?
That was the worry when Sergeant Major Calloway’s case came to light. He had revealed a “dangerous” level of humanitarianism in private correspondence to his friend Tomas Consunji (Boehringer 2009, 3):
After my last conference with you and your father, I am constantly haunted by the feeling of what wrong morally we Americans are in the present affair with you. . . . Would to God it lay in my power to rectify the committed error and compensate the Filipino people for the wrong done! . . . The day will come when you [Filipinos] will be accorded your rights. The moral sensibilities of all America are not yet dead; there still smolders in the bosom of the country a spark of righteousness that will yet kindle into a flame that will awaken the country to its senses, and then! (Quoted in Russell 2014, 209).
In 1901, when white soldiers of the 3rd Infantry searched Consunji’s home for evidence of ties to nationalists, they found the correspondence between the two men. They sent it on to Calloway’s commanding officer, Colonel Henry B. Freeman of the 24th, a white man who had only been in the country for three months (Boehringer 2009, 2). Though Calloway claimed that the letters only expressed “a personal feeling, expressed to a personal friend, [and] had no other intent or motive,” the colonel believed them treasonous.
Colonel Freeman wrote in the official report: “Battalion Sergeant Major Calloway is one of those half-baked mulattoes whose education has fostered his self-conceit to an abnormal degree” (quoted in Russell 2014, 213). If Calloway had an abundance of confidence, he had earned it through active service since 1892. He had done strike- and riot-breaking in the western mining states, along with hostage rescue, before fighting in three separate expeditions of the Cuban and Philippine fronts (Russell 2014, 215) and achieving the highest enlisted rank possible (Scot 1995, 166). Now, he wished to stay and invest his $1500 savings in a business venture in Manila, but he was thrown in Bilibid Prison instead. All this because of private correspondence, obtained by a possibly illegal search, that effectively said that imperialism was immoral—the very principle on which the United States of America was supposedly founded (Russell 2014, 212-13).
In this and future American wars, one of the key tenets of counterinsurgency has been that military action alone will not encourage forces of resistance to set down their arms. People must see the carrot, not just feel the stick. In the Philippine-American War, the military leaders called this strategy “attraction.” Later, during another counterinsurgency in the Philippines, this time against communists during the 1950s, it was called “civic action.” In Vietnam, civilians colloquially called it “winning the hearts and minds” of the people. Good rapport, then, is an asset, not a liability. If African American regiments were forming true friendships with Filipinos, why were the white commanding officers so angry?
The Inspector-General would state: “I regard [Calloway] as a dangerous man, in view of his relations with the natives, as shown by this letter, and the circumstances of his court-martial” (Boehringer 2009, 3). Colonel Henry B. Freeman said of Sergeant Major John W. Calloway: “In my opinion he is likely to step into the Filipino ranks, should a favorable opportunity occur” (Russell 2014, 213). General Arthur MacArthur, commander of the entire war and father of future General Douglas MacArthur, agreed: “It is very apparent that [Calloway] is disloyal and should he remain in these islands, he would undoubtedly commit some act of open treason and perhaps join the insurrection out and out. One man of the 24th Infantry by the name of David Fagen has already done so and as a leader among the insurrectos is giving great trouble by directing guerrilla bands” (Boehringer 2009, 3).
David Fagen’s story is worth a post of its own later, but this man was one of twenty-nine African American soldiers to desert the Army in the Philippines, and one of nine who defected to the Philippine Revolutionary Army (Robinson and Schubert, 73 n23). It is important to note that fourteen white soldiers also defected to the Filipino side (McCann and Lovell, 54), though that number was a smaller percentage of those who served in the islands. What particularly upset MacArthur about a Black soldiers’ defection was probably the phenomenon described by Ibram X. Kendi: “Negative behavior by any Black person became proof of what was wrong with Black people, while negative behavior by any White person only proved what was wrong with that person” (2017, 42-43).
Black soldiers were specifically targeted by Filipino propaganda leaflets that brought up the same questions their own papers were asking back home (New York State Division). One read:
To the Colored American Soldier: It is without honor that you are spilling your costly blood. Your masters have thrown you into the most iniquitous fight with double purpose—to make you the instrument of their ambition and also your hard work will soon make the extinction of your race. Your friends, the Filipinos, give you this good warning. You must consider your history, and take charge that the Blood of Sam Hose proclaims vengeance (Ngozi-Brown 1997, 46).
This letter was attributed to President Emilio Aguinaldo, but many believe it was penned by Foreign Minister Apolinario Mabini (Ontal 2002, 125), the polymath genius who had studied American history and society closely enough to reference the “spectacle lynching” and mutilation of Sam Hose of Newnan, Georgia. It was hard to ignore letters like Mabini’s. Even worse, it was hard not to notice how the new American regime was recreating the world of Sam Hose around them—and to wonder whether they, as soldiers in the US Army, were complicit in this expansion of segregation.
Racism and segregation in the military had clearly been at fault in causing Fagen’s defection. Fagen had been considered by his former white officers as “rowdy,” “bucking” his superiors, “a good for nothing whelp,” and “in continual trouble with the Commanding Officer” (Ontal 2002, 125). He had even been charged with seven counts of insubordination and punished with “all sorts of dirty jobs” (Ontal 2002, 125). After he defected, the colonial newspaper Manila Times depicted Fagen “as a gifted military tactician waylaying American patrols at will and then evading large forces sent in pursuit” (Ontal 2002, 126). He showed his former officers of the 24th Infantry exactly how wrong they were.
The fear of MacArthur and others was this: what if Calloway, the highest-ranking African American in the 24th, followed Fagen into the Philippine Revolutionary Army or any of the guerrilla organizations fighting in its name? Unlike Fagen, Calloway was already proven to be competent, highly-educated, and a fine leader. What damage could he do to the United States Army?
But this fear was all in their heads! There was no evidence that Calloway ever considered defection. He hoped for both peace and Filipino rights, but he trusted in the people of the United States to provide both. The fact that the white officers understood Mabini’s propaganda to be effective means that they recognized the truth of it—which means that they should have seen that it was American policy to blame, not the sympathies of Calloway. Nevertheless, the Army busted Calloway down to private and dishonorably discharged him. He would try to reenlist several more times, the last during World War I, but he would be denied every time (Boehringer 2009, 3).
He was not the only one to be disappointed. What progress had been sought by the “Black Phalanx” was lost in the extension of Jim Crow policies throughout the empire (quoted in Gleijeses 1996, 188). The US military would not be desegregated until the Truman administration after World War II, when America’s role as the champion of democracy would be questioned by foreign allies (Kendi 2017, 351). The professionalism, excellence, and courage of African American soldiers in the 1898 wars has been largely forgotten in white-dominated histories of the period.
[Featured image is a vintage postcard of the 25th Infantry at Basilan in the Sulu Archipelago.]
Brown, Scot. “White Backlash and the Aftermath of Fagen’s Rebellion: The Fates of Three African-American Soldiers in the Philippines, 1901-1902.” Contributions in Black Studies 13, no 5 (1995): 165-173. http://scholarworks.umass.edu/cibs/vol13/iss1/5.
New York State Division of Military and Naval Affairs. “Black Americans in the US Military from the American Revolution to the Korean War: The Spanish American War and the Philippine Insurgency.” New York State Military History Museum and Veterans Research Center. Last modified March 30, 2006. Accessed June 29, 2020. http://dmna.ny.gov/historic/articles/blacksMilitary/BlacksMilitaryContents.htm.
Ngozi-Brown, Scot. “African-American Soldiers and Filipinos: Racial Imperialism, Jim Crow and Social Relations.” The Journal of Negro History 82, no. 1 (1997): 42-53. http://doi.org/10.2307/2717495.
Robinson, Michael C., and Frank N. Schubert. “David Fagen: An Afro-American Rebel in the Philippines, 1899-1901.” Pacific Historical Review 44, no. 1 (1975): 68-83. http://doi.org/10.2307/3637898.
Russell, Timothy D. “‘I Feel Sorry for These People’: African-American Soldiers in the Philippine-American War, 1899-1902.” The Journal of African American History 99, no. 3 (2014): 197-222. http://doi.org/10.5323/jafriamerhist.99.3.0197.
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.”
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!)
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.
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).
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.
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.
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!)
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.”
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.
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!
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.
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.
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.
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.
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:
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.”
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. None. In fact, that would have been impossible, one professor complained, because half of his students “could barely write.”
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.
(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:
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 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.)
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 will also see in Sugar Communion. There is a deep backlog here 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 Curious Clinicians, the History Chicks, the Revisionist History podcast, Blowback, and This Land. (Some of these titles are related to other interests, obviously.) 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.
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.