SOURCE: Newberry, Frederick. “Male Doctors and Female Illness in American Women's Fiction, 1850-1900.” In Separate Spheres No More: Gender Convergence in American Literature, 1830-1930, edited by Monika M. Elbert, pp. 143-57. Tuscaloosa: University of Alabama Press, 2000.

[In the following essay, Newberry demonstrates how the feminization of medical care in the nineteenth century—with love, kind attention, and deference to female-specific needs—either supplants altogether the role of a male doctor or enhances that doctor's abilities, as illustrated by both Gerty and Emily in Cummins's sickness-ridden The Lamplighter.]

It might be supposed that Charlotte Perkins Gilman's “The Yellow Wall Paper” (1892), featuring a host of cultural conflicts involving a woman's mind and body as perceived by male doctors, would have a discernible lineage in American women's fiction of the nineteenth century. After all, the gradual and highly successful efforts of men to secure control over medical care in nineteenth-century America often took place in public arenas and thus brought with them a fair amount of social controversy. But it would seem to be a fact that Gilman's story does stand rather resolutely alone in pointing a finger of blame at male physicians for their failure to understand, let alone diagnose with some degree of accuracy, the physiological and psychological conditions of female patients. The apparent fact must therefore appear strange to anyone even vaguely familiar with the contrast between the positive representation of male physicians in women's fiction and the frequent negative opinion of them expressed throughout the century.¹ Probably more than anyone else, male physicians were historically responsible for proselytizing the outlook that women were physically and mentally inferior to men.² As adumbrated some years ago by Ann Douglas Wood, and more recently by Diane Price Herndl, this outlook led a lot of women to consider themselves as physiological, psychological, and intellectual weaklings.³ From our vantage, of course, there would seem to be no accident in the timing of this male-encoded pathology. At the very moment in the 1840s and early 1850s, when women were being accorded a certain measure of power through the entangled and exalting paradigms of the “cult of true womanhood,” at the very moment, furthermore, when the feminist and suffragette movements were accelerating, the vast majority of male doctors in the nation were pronouncing women as inherently frail.⁴

At roughly the same moment, however, there also existed quite a different view of women, one that Frances Cogan incisively and wittily presents in All-American Girl: The Ideal of Real Womanhood in the Mid-Nineteenth Century. According to a substantial amount of evidence assembled by Cogan, a good number of enlightened medical and cultural spokespersons—both men and women—advocated physical and mental equality, or virtual equality, between the sexes. This advocacy became all the more compelling were women to become especially informed about such matters as diet, exercise, dress, hygiene, menstruation, and preparation for the practical needs of living either a married or single life (Cogan 29-100). Implicit throughout Cogan's study lies the point that women would have served themselves better by ignoring the advice books and medical opinions of those men who simultaneously heralded their weakness and elevated them into the nether region of maternal beatitude. In other words, middle- and upper-class women had to resist the ideology of invalidism that accompanied the cult of domesticity.⁵

Whether the latter half of the nineteenth century actually witnessed a prevalence of weak, sickly, neurasthenic women remains somewhat uncertain. Herndl, who offers the fullest literary study to date on the subject, takes the precaution of qualifying her thesis in the light of Cogan's study (Herndl 22). Nevertheless, like others, she proceeds to select examples from fiction that specify numerous females afflicted with assorted ailments—both physical and mental, real and imagined. In all of these instances, girls and women evidently subscribe to the historically dominant view of them on the part of most male physicians: that women were in fact delicate and thus prone to illness. As far as I am aware, no major study other than Cogan's challenges the wide-scale application of this literary point of view,⁶ one that entails gathering culturally inscribed data from the historical record and then discovering analogous examples in fiction that seem to confirm the validity of the paradigms suggested by the data.

Despite my general admiration for Herndl's methodology, one incompatibility between the historical record and the fictional case deserves remark. In medical histories on the nineteenth century, abundant evidence reveals that many women, as well as some men, were not at all sanguine about the steady rise to preeminence of male doctors who had scant if any knowledge of women's physiology and who, for the most part, practiced a kind of “heroic” or allopathic medicine that more often than not inflicted greater suffering on the ill than did the symptoms of illness in the first place (Rothstein 65-78). As a result, it was not at all uncommon for men, but especially women, to choose to suffer rather than to consult a doctor; for male physicians were often considered frightening, ghoulish monsters because of their ignorance, incompetence, and insensitivity. No accident, therefore, that many women not residing in the cities, where male doctors initially solidified their professional status, continued to call on midwives, consulted with female herbalists, and initiated various self-help programs and health reforms that were especially relevant to their gender.⁷ No accident, too, that a cry went out, “Send us a woman physician” (Abram).⁸

A survey of major novels written by women during the last half of the century, however, reveals few examples not only of invalid women but also of the historical suspicion and denigration of male doctors. The husband of the narrator in “The Yellow Wall Paper,” along with the historical figure of S. Weir Mitchell—famous in his day and now infamous in ours because of the story—can be cited as exceptional instances.⁹ And I suppose that no one would want to exclude the father-in-law of Ruth Hall—in the novel so named by Fanny Fern—from the list of exceptions, though I'm not sure that Dr. Hall, when we bear in mind his cruel and shrewish wife, would qualify as a banner-waving advocate of women's demure and fragile nature. But these examples are the only ones that I have thus far discovered in my reading of the fiction in which women seem beset by physical or mental symptoms for which a male doctor is consulted.

Accordingly, questions arise. If, in the latter half of the nineteenth century, all of the ostensibly ailing or seemingly neurasthenic females in women's fiction necessarily reflect an unavoidable cultural inscription, as Herndl would have it, why does that fiction not echo, even on a minor scale, an equivalent cultural inscription: a negative portrayal of male physicians? Did women writers choose to accept the diagnosis that women are liable to illness; and by such acceptance, did they thereby not only valorize the demeaning opinion of women on the part of male physicians but also, inadvertently or not, aid in the deliberate effort of men to control the medical profession by excluding women? Or did they accept the diagnosis while ignoring the widespread opinion, especially outside the South, that male doctors were basically ignorant of women's physiological and psychological condition? And finally, what role or function do male doctors actually play in women's fiction? In the following survey of American women's fiction from the 1850s until the end of the century, I should like to engage these questions by examining female characters who do not conform with the model of invalidism advanced by Herndl and others, and by pointing to male doctors who do not reveal, whether scarcely or indisputably, a condescending, patriarchal view of women.

Maria Susanna Cummins's The Lamplighter (1854) presents a physician to whom women in need of medical attention might turn as an exemplary doctor and to whom women lacking such need might turn as a model of manhood. No one can read the novel without observing how it teems with disease and death; and hence at first glance it might seem to support the outlook of women's inherent fragility. But a careful consideration of the cases reveals that Herndl's thesis on invalid women does not have any substantive application to the book. Instead, Cummins evidently represents the extratextual world we all take for granted: people get sick, and people die, either from illness or old age. For instance, when early in the book young Gertrude is cast out into a cold winter's night without proper clothing, there's nothing fashionable or imagined about the fever she develops that results in her lying abed, semiconscious and delirious, for several weeks. Significantly enough, Trueman Flint, who has adopted Gertrude, does not call upon a physician to administer to the girl but cares for her himself. As Cummins puts it, Flint “knew a good deal about sickness; was something of a doctor and nurse in his simple way; and, though he had never had much to do with children, his warm heart was a trusty guide, and taught him all that was necessary for Gerty's comfort” (Cummins 16). Such care on the part of Flint contrasts with an episode recounted by Mrs. Sullivan that offers one of the few fictional examples of the low esteem in which doctors were held at midcentury. In the course of explaining to her son Willie the reason for her father's apparent sour disposition, Mrs. Sullivan reminisces: “Mother was taken down with her death-stroke, and there was a quack doctor prescribed for her, that father always though[t] did her more hurt than good” (39).

If anyone in The Lamplighter might qualify as a candidate endorsing the thesis on female invalidism, it would be Emily Graham, who seems vulnerable to periodic bouts of illness. Not until late in the book, however, does the reader learn that her physical ailments no doubt stem from a psychological trauma suffered years earlier. Moreover, Cummins emphatically addresses Emily's supposedly delicate constitution by essentially denying it: “The invalid girl, if we may call her such (for, in spite of ill health, she still retained much of the freshness and all the loveliness of her girlhood)” (394). Still, Cummins's most cogent point does not bear on the number of persons who suffer ailments or die so much as it does on the kind of care received by those who are genuinely ill or dying. In terms of nursing, the most important care issues from the love and sympathy extended by man or woman—the kind of care that Trueman Flint and Mrs. Sullivan give to Gertrude and that Gertrude in turn gives to Emily Graham. But in terms of professional medical care, Dr. Jeremy represents the ideal physician, for his mind and feelings are attuned to the physical and emotional needs of his patients. After Dr. Jeremy prescribes medication for the dying Mrs. Sullivan, for example, the woman remarks about him to Gertrude that he is “so different … from common doctors … so sociable and friendly! Why, I felt, Gertrude, as if I could talk to him about my sickness as freely as I could you” (163). Married to a woman with whom he shares an equal, mutually respectful, and loving relation, Dr. Jeremy assumes both a sympathetic and steadying force in the novel, obviously sensitive to the culturally inscribed burdens of women and just as obviously impatient with—and thus a splenetic vehicle through which Cummins vents her bile at—the sometimes tyrannical Mr. Graham, the patriarchal ogre who must undergo a kind of feminizing tutelage in order to become transformed into the sort of man, sensitive to women, that Dr. Jeremy is. Apparently having no children of his own, Dr. Jeremy serves as a romanticized father physician, similar to the one that Fanny Fern creates in Ruth Hall.

Although Fanny Fern excoriates one doctor in Ruth Hall (1855), she also reflects the variety of medical practitioners in the nineteenth century by including several others. Two of these are of note. The first is a Mrs. Waters who “styled herself a female physician. She kept a sort of witch's cauldron constantly boiling over the fire, in which seethed all sorts of ‘mints’ and ‘yarbs,’ and from which issued what she called a ‘potecary odor.’ Mrs. Waters, when not engaged in stirring this cauldron, or in various housekeeping duties, alternated her leisure in reading medical books, attending medical lectures, and fondling a pet skull, which lay on the kitchen dresser” (113). Whether this somewhat unattractive characterization of Mrs. Waters hints at Fern's general opinion of traditional women herbalists or at an unsavory figure in Fern's life cannot be determined. But in happy opposition to this mixed characterization of Mrs. Waters appears another physician who registers an alternative to the heroic medicine practiced by Dr. Hall and the herbal remedies brewed by Mrs. Waters. In the boardinghouse where Ruth first wins fame as a writer resides the mysterious Mr. Bond, to whom she turns after her youngest daughter, Nettie, becomes seriously ill. Mr. Bond turns out to practice homeopathic medicine, thereby reflecting Fern's awareness at midcentury of that popular alternative to the aggressive, heroic medicine endorsed by most male physicians.¹⁰ In the light of Ruth's earlier experience with three male physicians, including Dr. Hall, who have been unable to prevent the deaths of her first daughter and her husband, well might the reader imagine that Ruth would feel some reluctance in consulting Mr. Bond. Having nowhere else to turn, however, Ruth allows Mr. Bond to see Nettie; and he successfully prescribes a dosage for the child. Significantly, Ruth senses that Mr. Bond “was a man of refined and courteous manners. … Ruth felt glad he was so much her senior; he seemed so like what Ruth had sometimes dreamed a kind father might be” (127).

In this highly charged remark, which throws into relief Ruth's relations with her uncaring father and horrific father-in-law, Ruth echoes Mrs. Sullivan's opinion of Dr. Jeremy in The Lamplighter. Taken together, both opinions record an attitude toward the bedside manner of Dr. Jeremy and Mr. Bond that contradicts the manner endorsed by most male physicians throughout the latter half of the nineteenth century. As Mary Roth Walsh argues, “Sternness, control, efficiency, strength, and organization were terms late nineteenth-century doctors liked to use to describe themselves” (139). Such terms served not only to reflect men's threatened conception about themselves as professionals but also to help erect a patriarchal barrier against increasing numbers of women who sought to become doctors and who had quite a different conception of professional behavior.¹¹ Cummins and Fern suggest this conception—taking up in their role as novelist the historical function of women physicians—to feminize the profession. It therefore seems to me that, more than anything else, the positive characterization of male physicians in women's fiction serves as an idealized projection of the qualities that women would like not only doctors but also men in general to possess: a sympathy and understanding altogether free from condescension toward women. Hence the paternal kindness that Mrs. Sullivan detects in Dr. Jeremy or that Ruth senses in Mr. Bond should not be confused with a patriarchal power to which women are constrained to submit. …

Notes

1. For the rise of male physicians and the controversy over the establishment of their power through such means as scientific knowledge, medical schools, and professional organizations, see Rothstein; and Starr 3-197.

2. For an incisive account of the role played by male physicians in promoting the view that women were mentally and physically inferior to men, see Ehrenreich and English.

3. See Wood 25-52 and Herndl 20-74. For information on the argument that women were inferior to men because of their having smaller brains, see Haller and Haller's chapter “The Lesser Man” (47-87). Behind Herndl's study and my own lies a massive body of material impossible to cite here. Interested readers might well begin with the substantial studies of Carroll Smith-Rosenberg and Charles Rosenberg; a good place to begin might be their essay “The Female Animal: Medical and Biological Views of Woman and Her Role in Nineteenth-Century America” in Leavitt 12-27. Wood's essay may be also be found in this collection (222-38).

4. For the relation between the cult of domesticity and women's inferiority, see Harris 32-72.

5. Cogan's study, of course, itemizes many advice books for women that did not assume feminine weakness. For a view, suppressed in feminist literary studies, that the cult of domesticity and its corollary, the angel in the house, had a liberating effect on middle-class women, see Achterberg 134-36.

6. Because it embraces medical circumstances of men and women, I exclude from consideration Joan Burbick's Healing the Republic.

7. For critiques of the invasive practices of male physicians and discussions, along with medical reform movements and self-help programs sponsored by women, see Risse et al.

8. Evidently, around mid-century there was a fairly strong movement to encourage women to enter the medical profession, judging from the number of articles in magazines that promoted the issue or gave attention to it. See “Female Doctors”; “Females as Physicians”; “Female Medical Schools”; Dowler; Gross; King; and Wilson.

9. Mitchell, trained in neurology and a believer in somatic causes of psychological disorders, has somewhat unfairly won a bad reputation as a result of the widespread critical attention given to Gilman's story. For a balanced treatment of the man and his work, see Poirier.

10. According to Rothstein, evidence suggests that women interested in medicine were more attracted to homeopathy and more welcomed by the homeopathic schools than by regular medicine. The popularity of homeopathy for women rose steadily throughout the latter half of the century. “Homeopathy, like the other nonregular sects, had many more female practitioners than regular medicine did. In 1900, women constituted 5 percent of the students in regular medical schools, 9 percent of the students in eclectic schools, and 17 percent of the students in homeopathic schools. … In the same year, 12 percent of all homeopathic physicians were women” (300-301, n. 5). For further information on women's attraction to homeopathy, see Hurd-Mead and Moldow.

11. See Walsh 106-46 for the reactionary efforts of male doctors to solidify their power under the threat, beginning in the 1870s, of women seeking to enter the profession and feminize it.

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