History of Medicine Lecture at OHSU Friday, October 18 at noon in the Old Auditorium

I'm delighted to have the opportunity to share some of the research in my next book project at the OHSU History of Medicine Lecture:

"Venereal Girls”, The Cedars Detention Home, and the Portland Free Dispensary: Gender, Public Health, and Civil Liberties in the First World War and its Aftermath

Public lecture: 12:15pm
Refreshments served at noon
Location: OHSU Old Library Auditorium

http://www.ohsu.edu/xd/education/library/about/collections/historical-collections-archives/

Guest Blog by Danielle Budlong

Part Two of The Immortal Life of Henrietta Lacks, “Death,” is arguably the most historically significant and fascinating section of the book [Rebecca Skloot, The Immortal Life of Henrietta Lacks (New York, Random House Inc., 2011): 89-176.]. It begins with the end of her life, but the beginning of her immortality. Serendipitously, Dr. Lawrence Wharton Jr., Henrietta's surgeon at Johns Hopkins where she was treated for cervical cancer in 1951, had collected a tissue sample from her tumor [Skloot, 31,33]. Dr. George Gey's assistant in the tissue culture lab soon discovered that Henrietta's cancer cells did not die like every other human sample thus far, but reproduced prolifically [Skloot, 40-41]. This would begin the journey of her cells of an epic proportion, a journey that would raise serious ethical questions, conjure metaphysical fears, and bring about more scientific discoveries than anyone could have imagined.
    In the absence of the regulation and oversight that the medical research community has today, the doctors that obtained Henrietta's cells, HeLa, had virtually free rein. They were bought, sold, given away, injected into patients, often without their consent. African Americans, Jews, and prisoners were used as test subjects, more often than not without their consent or with minimal notification of the dangers involved in the particular study [Skloot, 128-130,167,]. Researchers fused mouse cells with HeLa cells, not for nefarious reasons, but panicking the public, to whom the media fed images of half-human, half-animals  [Skloot, 142-143].
    However, research flourished, while Henrietta's family did not. Microbiological Associates used HeLa to start the first large-scale cell distribution center, spurring a multibillion-dollar industry [Skloot, 100-101]. Meanwhile, Henrietta's children had to be distributed to family members, where they were abused and in poverty. The grown Lacks children have intermittent insurance, major health problems, and still live in poverty [Skloot, 163]. However, through all of this activity around HeLa, researchers accomplished great things. They realized the need to standardization in cell culture to efficient and repeatable research. The cells were used in the research that resulted in the polio vaccine [Skloot, 96-99]. The cells were instrumental to the process of gene mapping and have contributed to the development of chemotherapy drugs [Skloot 139,142].
    Henrietta's family was not aware that any of this was going on. Due to tradition, superstition, and lack of information, they related to the world in metaphysical ways. They used fears of the supernatural to help explain the events that they did not understand. This was partly due to the fact that the medical community that was working with HeLa cells did not bother to learn about the women from whom the cells came, let alone consider the family. When Henrietta's children were little, they had to stay away from Johns Hopkins for fear that “Hopkins might get us,” and this fear was probably in part based in reality [Skloot, 165-167]. Henrietta's cousin tells the story of Henrietta's funeral service, when, as they were covering her coffin with dirt, a violent storm broke out and killed a family member [Skloot, 92]. The family did not understand what happened to Henrietta, so there must have been something supernatural at work. Skloot experienced this firsthand when she visited Henrietta's cousin “Cootie.” He explained that since Henrietta died, but her cells lived, the sickness must have been the result of either voodoo or the work of the doctors. He described seeing an enormous, headless, tailless hog, dragging huge chains, getting ready to charge at him one night, but luckily the apparition was scared by a car and ran off into the family cemetery [Skloot, 81-82].
    The underlying question Skloot seems to be asking is, after all of the scientific breakthroughs that came from the studies of HeLa, was it worth it the ethical transgressions? The medical community would likely answer in the affirmative, but may have a more difficult time answering the question, does her family deserve a part of it? They took Henrietta's cells without consent, and even though that may have been common practice at the time, she still deserves to be recognized and honored. Providing her heirs lifetime full medical coverage seems a small price to pay for what they reaped from the use of her body....But who should pay?

Guest Post by Sarah Murphy

Medical Advancement versus Cultural Beliefs

The LIFE of Henrietta Lacks

            To be moved, conflicted and evermore curious you only need to start reading Rebecca Skloot’s The Immortal Life of Henrietta Lacks [Rebecca Skloot, “Life,” The Immortal Life of Henrietta Lacks, (New York: Crown Publishers, 2010)]. The first part of her book, entitled “Life,” makes you question the development of the modern medical field, and draws you into the story of a woman’s life that has greatly been overlooked in the history of medicine. Henrietta’s cancer cells would be found to never die, unlike most human cells; Henrietta Lacks’ cells would become known as HeLa. Skloot intricately ties together a complicated timeline that involves the medical developments leading up to the “discovery” of the HeLa cells, what is known of Henrietta Lacks’s life up until her death in 1951, the beginning of Skloot’s journey to discover the story of Henrietta and her family and trying to put the reader into the culture of the mid-20th century that included racism, sexism and elitism that is difficult for us to comprehend.

            Part One develops as Skloot travels back and forth between her personal journey to discover more about Henrietta Lacks and the series of developments in cell cultures and cancer-fighting technology. She starts with Henrietta’s first exam where she was diagnosed with cancer. Outlining the foreign nature of hospitals to those who grew up outside of the medical culture, like Henrietta, and especially the difficulty of receiving medical care as a poor African American in Baltimore, Maryland. Skloot talks about Henrietta’s life from her childhood up until her diagnosis. To balance the story, Skloot includes a couple of chapters of medical developments and discusses the complex views of the medical field by the public, particularly surrounding cell cultures. The last aspect of Part One revolves around Skloot’s personal journey to get in contact with Henrietta’s family, and her tumultuous start to uncover a family’s history of loss, distrust and manipulation.

            While the story unweaving before the reader brings a whole mix of emotions, one of the main aspects of Skloot’s Part One is the conflict between general population, specifically the rural poor, and the development of the medical field. There was a complete disconnect between the developing medical field and public understanding and acceptance of modern medicine. Henrietta was just one of the many that came to a hospital, but not understanding fully her diagnosis or the treatment implications. While it was common practice for doctors to explain that radiation treatments would most likely make her infertile, Henrietta did not understand until it was too late that the treatment would make it so she could not have another child (Skloot, 46-7). A gap in language and understanding was the likely culprit of this tragic misunderstanding, but the fact the Henrietta also did not grasp the seriousness of her condition, and that it was likely a choice between fertility and life, and she said if she had known she would not have gone through the radiation treatments (Skloot, 47).

            With such a disconnect in understanding and priorities it is not surprising that many people did not want to have biopsies taken to be used for experimentation, but without this practice medical advancement would likely not have occurred at the rate it has. Even though Henrietta’s husband was asked if doctors could take samples of Henrietta’s cells after her death, his lack of full understanding of the implications did not prevent them from taking those samples, and continue using the samples previously taken without Henrietta’s knowledge. While we would like to say that the doctors were purely in the wrong, without Henrietta’s “immortal cells” many of the medical advances that they lead to would not have happened, or at least would have not had happened as early as they did.

            There is an ethical issue that people still struggle with today regarding the line between patient permission and medical advancement. Had Henrietta been more educated and had an explanation about the impacts her cells could have on the world, would she have agreed? Do doctors have the right to disregard cultural beliefs in the name of saving lives? Skloot has only begun to dive into these issues in Part One, but her open-minded pursuit of the truth allows for a controversial issue to be addressed from all sides simultaneously. The level of respect Skloot brings to the varying interpretations and lives involved in the “discovery” of the HeLa cells allows for a productive conversation around a part of history that is often brushed aside and forgotten, but is very much relevant.

Guest Post by Annie Potter

Controversial and Chaotic Contraceptives

The pill was one of the most controversial issues raised in the 20th century. During this period of time there was a real concern of overpopulation worldwide and the dwindling amount of resources. “ Thus fear of self-annihilation through the depletion of natural resources meshed easily with Cold War concerns about the spread of communism and nuclear extinction”[Andrea Tone, Devices and Desires: A History of Contraceptives in America. New York: Hill and Wang, 2001, 200-292].

Feminists feared that the big drug corporations were using women as guinea-pigs to further the development of the birth control pill. To women in the 20th century it was freedom, freedom to control one’s body. Filled with fear and suspicion the African-American population considered the pill a form of racial genocide. “Throughout the 1960’s and 1970’s nationalists reiterated the long standing fear that birth control would lead to race suicide by subduing the size and strength of the black population. African-Americans could not afford attrition at the time when blacks had finally gained, through the Voting Rights Act of 1964, the promise of universal suffrage. Large black families were the community’s insurance against racial experimentation, its best promise for political and social gain” [Tone, 254-255].

Margaret Sanger and Katharine McCormick took interest in the pursuit of the birth control pill. A pill that would place women in control of their bodies. In Margaret Sanger’s point of view the pill would liberate women from the control and reliability of men to prevent pregnancies. “ The pill accomplished what the diaphragm had not. It created widespread doctor and patient acceptance of medical birth control” [Tone,201]. With the determination of Sanger and the financial backing of McCormick the development of pill would occur through the work of two scientists (Dr. Pincus and Dr.Rock). Although Sanger was a supporter of the pill McCormick kept a close watch on Pincus and the development of the pill. The first large-scale clinical trial for birth control was held in Puerto Rico where Pincus believed was far away from the probing American media. The result of the trial proved mediocre at best and several horrible side effects occurred. “ Then too, there were the medical side effects: nausea, dizziness, headaches, stomach pain, and vomiting” [Tone, 223]. Pincus thought the side effects were minimal enough that the pill still could be marketed within the United States. In 1957, the oral contraceptive Enovid was released to the general public. Most American women overlooked the side effects because the benefit of non-pregnancy was extremely effective. This opportunity provided women with choices concerning family matters and career aspirations.

Although the birth control pill was a promising contraceptive IUDs would become America’s most used contraceptive. “ In this political climate, the development of intrauterine devices seemed a godsend. Cheaper than the pill, virtually impossible for a women to remove, and requiring only a single ‘ motivated’ act--the decision to have one inserted--the IUD seemed too good to be true” [Tone, 263]. The most notable and infamous IUD is the Dalkon Shield created by Hugh Davis. Later Irwin Lerner modified the Dalkon Shield and filed a patent as the sole inventor. The Dalkon Shield was released in 1968 and over two million women used it. The Dalkon Shield was cited as the most effective and safe IUD in the market. Later the Dalkon Shield would prove to be anything by reliable or safe. The “Dalkon Shield caused over 200,000 infections, miscarriages, hysterectomies, and other gynecological complications and led to an untold number of birth defects , caused by contact between the device and the developing fetus” [Tone, 279]. Unfortunately, the FDA had limited power to regulate the medical device industry. Only after the fact of ineffectiveness and danger could the FDA remove the product.“ In 1984, the company’s legal team was rattled by the actions of Judge Miles Lord, a federal judge in Minnesota who had been assigned to hear twenty-three Dalkon Shield cases...The judge’s consolidation order denied the company the opportunity to defend itself by examining and attacking each plaintiff’s sexual history” [Tone, 281]. Dalkon Shield lost the lawsuit and thus resulted in the recall of the product in 1984.

Guest Post by Allison Barker

Sanger’s Dilemma

Most folks have at least heard of Margaret Sanger, the 20th century feminist and proponent of birth control access.  Focusing on her work from the 1920s onward, Sanger faced a not-so-unique dilemma.  A not-so-unique dilemma faced by many past and present progressive movements:  the separation of an issue (in this case, women’s access to birth control) from the oppressed group struggling to achieve their goals.  We’ve seen this in the woman suffrage movement (moving the focus from woman suffrage to arguments of state pride and the benefits for male voters) as well as the modern LGBTQ rights movement (moving the focus from the voices within the LGBTQ community to awarding non-LGBTQ people for their behaviors/achievements).

One particular dilemma faced is outlined in various sections of Andrea Tone’s book, Devices & Desires.  Sanger, infamous for her then-illegal birth control clinic in New York established in 1916, envisioned a populist approach to contraception “where women from all walks of life could use contraceptives without reliance on doctors” [Tone, Andrea. Devices & Desires: A History of Contraceptives in America. (New York: Hill and Wang, 2002), 118].  Sanger soon distanced herself from this approach, as well as distancing her birth control advocacy from women’s rights.  Instead of advocating for birth control as a woman’s right to contraception, Sanger chose to focus on birth control from a medical standpoint.

During the 1920s Sanger was committed to inexpensive/free birth control for women (without the need for a doctor).  Period.  It was a radical idea for the time, one that not even the National Woman’s Party (formed by Alice Paul) would support.  Sanger quickly learned two things: the extent of sexual reform was extremely limited in the early 20^th century, and the political and social influence of medical science was greatly increasing.  “Narrowing her agenda, she sought birth control allies through an ideology that trumpeted women’s health over their civil liberties and cast doctors, not patients, as agents of contraceptive choice” [Tone, 125].  Sanger also began to oppose over-the-counter contraceptives “whose use bypassed physician expertise” [Tone, 125-126].

Herein lays the dilemma. Sanger’s focus on contraceptives as purely a medical issue accomplished two things: it created distance from the woman’s movement (which was costing Sanger many male allies) and began to bring doctors and physicians (who were dominantly male) into Sanger’s corner.   Do to Sanger’s efforts (and ironically the Comstock Laws, which permitted prescriptions by physicians), birth control could now be watched over by experienced medical professionals further legitimizing contraceptives, but at the cost of putting health above patients’ rights. 

Sanger became stuck in an interesting pickle on the topic of women’s rights.  On one side she opposed the use of condoms “because they forced women to depend on men for fertility control,” [Tone. 126] but due to her result-motivated approach to the medicalization of birth control, “doctors’ power [increased] over women’s bodies” [Tone, 138].

Unfortunately for Margaret Sanger, her ideals regarding accessible and safe birth control for women became a by-product of her time.  The early 20^th century was not a friendly time regarding both the morality of women’s rights and of contraceptives.  The era was ripe with ideas similar to those of Anthony Comstock in regards to equating birth control to promiscuity and murder (in the case of abortion).  Sanger needed to ally herself with doctors and big businesses (suppliers of contraceptives) and put medical science before patients’ rights in order to make any progress during a very restrictive era.  It is important to note that while Sanger advocated for medical involvement in contraception, she understood that working-class peoples (the demographic she primarily focused on in her clinics) would have restricted access to medical professionals.  Tone ends the chapter stating that “to her [Sanger’s] credit, she never gave up her goal of quality birth control for all” [Tone, 149]. But due to the volatile nature of morality (such as the morality that drove Anthony Comstock’s obscenity crusade) on the topic of women’s issues in the early 20^th century, it is impressive what Sanger managed to accomplish.

Guest Post by Liz Girres

The Creation and Use of Birth Control in Different Socioeconomic Classes

            Socioeconomic status has always played a part in who could create or obtain birth control. When the Comstock act was first passed in 1873, major companies had to stay out of the illegal distribution of birth control as to not harm their reputation [Andrea Tone, “Devices & Desires: A History of Contraceptives in America” (New York: Hill and Wang, 2001): 1-87.]. That being said, not all of them did. Samuel Colgate was president of the New York Society for the Suppression of Vice (NYSSV), and heir to a soap company [Tone, 28]. Even though he was fighting against obscenities, he put out a pamphlet about how Vaseline was a good contraceptive [Tone, 28]. He wanted to oppose obscenities but profit from them at the same time. Colgate was part of the elite class and was never charged for distribution of lewd materials. This exemplifies the biased enforcement of the Comstock Act. More often than not it was the smaller business owners that got arrested.

            It makes sense that bigger businesses would get more leeway when it came to the distribution of birth control. They had money and money is power. They were able to disguise their intentions in seemingly harmless ads. One example of an ad was for “Sanitary Sponges for Ladies” [Tone, 38]. They were sold under the pretense that women needed to keep their vaginas sanitary. When they were full of antiseptics they would get rid of germs [Tone, 38]. However, it was obvious that the real purpose was to kill sperm and prevent pregnancy. The bigger businesses were able to get away with advertising contraceptives because of their already respectable names.

            Margaret Sanger believed that the elite class had more access to better birth control than the working class [Tone, 79]. She saw women in the tenements that seemed to be in desperate need of birth control. She saw women waiting to get an abortion because they couldn’t afford preventive birth control [Tone, 79]. She thought that the upper class has more knowledge of birth control than the working class. The ignorance of the working class led them to rely on gossip about birth control. They also didn’t have as much money to pay for the products [Tone, 80]. However, many scholars believe that Sanger exaggerated a lot. Her conclusions didn’t always match up with what she described [Tone, 80]. If a woman was able to pay five dollars for an abortion, why couldn’t she have just bought a twenty-five cent condom to begin with [Tone, 80]?

            Logically, the availability of birth control to both classes makes sense. The upper class had more money to pay for it and more resources to find it. The lower class had more need for it and shared with each other different methods and places to get it. It seems likely that the lower class had a greater need for contraceptives. They had large families that needed to be fed on a lower salary. Spending a few cents on contraceptives could save them a lot in the future. They would have less stress and will be able to take care of their other kids better.

            The use of contraceptives in different classes is significant because of its implications on the health of women. Some of the methods were very unsafe and could cause a lot of harm. Condoms were reused multiple times, which could have led to infection and the spread of disease. IUDs could be made my anybody, and were often made of metal, glass, or wood [Tone, 61]. In the lower classes, they did not have money to afford a doctor and women could die from using certain forms of birth control. The upper class had doctors and possibly more knowledge of safe forms of birth control. Socioeconomic factors played a big role in the distribution, conviction, and use of different people.

Guest Post by Michelle Smail

Nursing Professionalization: Good, Bad, or Just Ugly?

           

Professionalizing nursing would “standardize and raise” [Susan M. Reverby, Ordered to Care: the Dilemma of American Nursing, 1850-1945. Cambridge: Cambridge University Press, 1987,121-207] the educational requirements as well as creating a greater amount of power and professional recognition for those nurses who would also be part of a smaller pool of nurses thus increasing job availability. However, there were many consequences for these advancements . Many women who had become nurses, particularly working nurses, would find themselves excluded [Reverby, 121]. This professionalization, which came with demands for higher wages and greater respect in the work force, also created a dilemma of how to maintain their status as ladies while still pushing for these changes. Such professionalization also threatened the men of the hospitals who worked as doctors, surgeons, and administrators because they feared that such professionalization would create competition for them and would decrease their relatively cheap work force of student nurses [Reverby 121].

A graduate nurse’s place in the medical community was already unique and isolated before these pushes were made. Professionalization seemed only to further alienate her from the largely male members of the medical community as well as working nurses whose goals and desires in regards to their nursing careers were vastly different from that of the upper class graduate nurses who were organizing and directing these professionalization attempts. This can be seen particularly in the educational standards that were put forth by the upper class graduate nurses. They pushed for requirements of high school diplomas and tighter restrictions on the issuing of licenses. Yet they ignored reform issues such as wages and forbade unionization because these actions seemed unprofessional and shallow in contrast with the ideals that the upper class graduates valued.

 Because smaller schools often did not meet these educational standards, graduates of those schools often found themselves fighting the professionalization of nursing because they feared “to have their status and standing lowered” [Reverby, 127] when the standards held strong legal backing. Along with opposition from the small school graduates, there was opposition from many of the state-nursing board members in regards to the requirement of a high school diploma to be a registered nurse. This is not altogether shocking when one considers that many of those members “were not themselves high school graduates” [Reverby, 127].  In an ironic twist, as the nursing community was trying to create an educational line to who was and was not a professional nurse, they were fighting against physicians who didn’t want nursing to be professionalized for the simple reason that they believed that “nurses are helpers and agents of physicians; not co-workers or colleagues” [Reverby, 131].

The essential split in these two groups of nurses seeking reform was that, “those eager for registration and higher standards focused on entry requirements and nursing education, whereas nurses already in the field were occupied with the conditions they faced at work” [Reverby, 134]. So rather than a united community of nurses taking on the medical community and gaining better pay, increased avenues of employment, and greater respect in the workforce, these two factions spent a great deal of time fighting against each other instead. Furthermore, the working nurses felt alienated from the upper class nurses because “they refused to accept the judgment that only those with pure noneconomic motives could be true nurse” [Reverby, 131]. This was one of the largest points of contention between the often upper class nurses from large schools that held the positions of leadership within the nursing organizations. These working nurses actually needed the funds from their work to support themselves and often a family. Therein lies the difference, their motivations and backgrounds were so very different that seeing eye to eye became nearly impossible.

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Guest Post by Carol Santos

Character As Skill: The Ideology of Discipline

A person who wants to study in order to be a nurse, teacher, or other field needs to go to school and be organized. Florence Nightingale was a woman who influenced the model for the training of American nurses in the nineteenth century. As Susan Reverby notes, Nightingale believed that character was the skill… “critical to the ‘reformation’ in both nursing and hospital care.” [Susan M. Reverby, “Ordered To Care: The Dilemma of American Nursing, 1850-1945 ,(Cambridge: Cambridge University Press, 1987), 41.] This was very interesting because in order for a woman to be a nurse, skill was not that necessary; instead, character was important and that was the skill a woman needed to have. Another strategy for women to enter in the field of nurse was “discipline” because they were carefully trained for homes and hospitals. One of the biggest reasons why Nightingale started a model and disciplined nurses was the fact that she faced disasters in the military and civilian health care. She fought for the training of “proper” nurses. Nightingale did not wanted to see this again and because of her ideas and contribution to a better change in the world of health she wanted to see character as a skill.

“The ‘Nightingale model’­ thus emphasized character training and strict discipline, a distinct field of work for nurses separate from physicians, and a female hierarchy with deference and loyalty to physician authority.” [Reverby, 43.] If a woman truly wanted to be a nurse, she would need to be serious in this field and not mix in feelings or problems while getting trained. Nightingale was very serious in training nurses and perfecting them because nurses were needed in homes or hospitals. She really wanted women who truly wanted to be nurses and were passionate about it.

Also, behavior was very important while taking classes in order to be a nurse. Behavior was expected from every student because as in any family or institution, behavior is widely from the expected norms. Since behavior was important, they also needed to have spirit in order to become a nurse. They needed to be passionate about being a nurse so the students could graduate and get recommendations letter from physicians or nurses. At the same time, lessons were very crucial and strict by physicians and nurses. This was to teach students a lesson and once they graduated, they would change the way they were before. An example of this is when a teacher told her graduating students, “You have become self- controlled, unselfish, gentle, compassionate, brave and capable- in fact, you have risen from the period of irresponsible girlhood to that of womanhood.” [Reverby, 58.] Students would become well educated, even though teachers were really hard with them.

Many physicians and nurses followed the Nightingale model that taught the students the proper ways, manners, and character to have as a nurse while working in homes or hospitals. Character was expected from students because that was a skill a person needed to have. Even though rules were very strict in medical schools, students were graduated with different personalities. Students would differentiate work, way of conduct, and character as skill.   

Guest Post by Kelsie Champ

A Woman’s Duty

Caring has always been seen as a feminine quality. Women care for their homes, children, and husbands. Taking care of the sick also falls to the family’s women. Most accept this part of their lives as their womanly duty. But what happens to the idea of caring when women starts to get paid for it? Are they revered? As one often sees in women’s history of labor, the answer is no. Instead, as Susan Reverby writes about in her book Order to Care: The Dilemma of American Nursing 1850-1945 their work is marginalized [Reverby, Susan M. Ordered to Care: The Dilemma of American Nursing, 1850-1945. Cambridge: Cambridge Univ. Press, 1987. 1-36.]

Nursing really began in family homes. Here mothers, sisters, wives, and daughters stepped up to help take care of ailing family members [Reverby, 11]. Out of concern for those in their care, some women tried to learn as much as they could about healing and how to properly take care of people [Reverby, 12]. As the middle-class grew in wealth the women that were in need of money and who had come to be known as good healers, were employed to take care of other families ill members [Reverby, 11]. These women were often older, widowed, white woman from poor backgrounds [Reverby, 14]. And they were not considered healers but more of a higher domestic worker [Reverby, 15]. Early nurses had no set list of activities they had to do. The matron of the home they were employed in could have them doing everything from actually taking care of her patient to doing housework and cooking [Reverby,15]. Nurses working in the home could be held anywhere from high esteem from their community to some of the lowest members of their community [Reverby, 15].

Women working as nurses in people’s homes could be considered valued members of their community. But for those working in early hospitals this was never the case. Florence Nightingale said that hospital nurses “were too old, too weak, too drunken, too dirty, too stolid, or too bad to do anything else” [Reverby, 22].  This is not total truth. But what is true is that many hospitals of the time were far too disgusting to keep anybody then either the very devoted or the very desperate [Reverby, 28]. Nurses were usually also patients mobile enough to help care for other patients [Reverby, 27]. Not all nurses were “bad” people or patients. If a woman could stick it out long enough she could learn a great deal from experience and doctors [Reverby,32]. As in all things what actually took place in a hospital differed from place to place.

“Ordered to Care” is the best way to put some of America’s early nurses. Caring was tied to being a good women and Christian. But it was also long and grueling when her other duties had to get done as well. When disposable income became a part of an emerging middle class it’s not shocking many looked for help from others to do it for them. It is hard, however, to shake off a sense of duty. While nurses were paid to do this job it was still strongly attached to their identity as women. Because of this one can easily see the lack of respect that is often tied to the profession of nursing. And clearly not the respect that these women deserved for doing the hard job others did not want.

Guest Post by Cody Rogers

The Hidden Costs of Paying For School:

A Look at The Struggles of Esther Lovejoy's Path to Becoming a Physician

            Esther Pohl Lovejoy faced many financial barriers to becoming a female physician. Financial hurdles were sometimes linked together with gendered barriers to form what could have been an impossible obstacle. However, Esther was not stopped by these barriers because she had a determination to escape her working class family background and gain an independent life, free from being dependent on a husband or anyone else. The lengths she would go to becoming a physician can be inspiring for us today and show the challenges faced by women who wanted to work in medicine at the turn of the 20^th century. [Kimberly Jensen, "Becoming a Woman Physician," Oregon's Doctor to the World: Esther Pohl Lovejoy and a Life in Activism. Seattle: University of Washington Press, 2012. 33-55.]

            One of Esther Lovejoy's biggest hurdles was the financial burden of paying for school. Esther came from a large working class family and at the time that she applied for medical school, she and two of her brothers were helping their mother with expenses by working as clerks in department stores.  [Jensen, 36.] Kimberly Jensen points out that her own family felt she had taken on too large a job and while she was able to pay for the first year of tuition amounting to 120 dollars, she had to drop out to raise more money after just one year in school. [Jensen, 36] This meant that even if she were able to raise more money to continue her school, she would be with different students and be forced to start up new relationships. Esther said herself about having to leave school that, “....There were no scholarships to be won...” [Jensen, 36-37.] There being no scholarships is an important point for us to remember in today's world where students are able to get scholarships or at least take out loans.

            This financial barrier was heightened by the role of gender in the department store where she worked to raise money. In the first store she worked at, Lipman and Wolfe, Esther talks about her direct boss, a floorwalker. This man was antagonistic toward women becoming doctors and quickly came to represent all the negative attitudes concerning professional women. While her main barrier at this time was financial in nature it had become gendered as well. Eventually the supervisor confronted her about studying human bones on company time and in front of the high-class customers. He gave her an ultimatum that she would either have to give up her dreams of being a doctor or lose her job. This very easily could have been the end for Lovejoy's dream of becoming a doctor, but Esther was lucky because she had a fellow co-worker who was able to secure her a job at Olds and King, another department store. [Jensen, 39.]

            This story gives us one great example among many of how the financial cost of school, especially an expensive type like medical school, can lead to barriers of a different nature. The cost of dealing with persons in power who are hostile to women or minorities, and even the jobs themselves, take a heavy toil on people who must work to go to school. Esther Lovejoy faced many more barriers, including gendered ones such as being denied an internship because she was a woman. [Jensen, 49.] However, I have chosen to focus on the financial burdens Lovejoy faced, because I feel institution can learn from them today. While a school might be completely gender unbiased in who it admits and the way it teaches, the world is not. Therefore, it is important for universities to understand the full cost and burden that high tuition fees can cause outside of the “safety” of the university.

Guest Post by Zachary Jones

Exclusionary Tactics and the Masculine Codes of Honor: An Examination of Robert A. Nye’s Analysis of Women’s Admission to the Medical Profession in the Nineteenth Century

Robert A. Nye’s chapter titled: “The Legacy of Masculine Codes of Honor and the Admission of Women to the Medical Profession in the Nineteenth Century,” is an excellent synthesis of recent scholarship in the field of the history of women in medicine. Nye has noted that the historiography of women’s exclusion from these professions has often been interpreted through the lens of the “pipeline” metaphor. Drawing on this metaphor, (the idea that at all stages of a woman’s education, training, and practice, women have been forced to cope with obstacles that have put them at a “cumulative” career disadvantage). Nye argues that this interpretation lacks solid footing because it has the potential to reintroduce a “friendly version of essential gender difference.” Thus, because of this interpretation, scholars do not consider the culture of work practices within male-dominated professions and their effects on the inclusion of women into their ranks. It is with this brief synthesis that Nye asserts in his thesis that the exclusionary “masculinization” of the nineteenth century medical profession was a consequence of the social practices that were not originally intended to exclude women, but were set in place to prevent the admission of a “certain kind of man.” (Robert A. Nye, “The Legacy of Masculine Codes of Honor and the Admission of Women to the Medical Profession in the Nineteenth Century,” in Women Physicians and the Cultures of Medicine, eds. Ellen S. More, Elizabeth Fee, and Manon Parry (Baltimore: Johns Hopkins University Press, 2009), 141-159).  

            Within the body of Nye’s work, he asserts that aristocratic man’s historical independence within civilized society, a class based phenomenon, allowed for the exclusion of men that could not emulate the independence that upper class men asserted in the secret societies that proliferated throughout the nineteenth century. As Nye notes, such organizations as the General Medical Council, (created in 1858) were formed for the purpose of professionalizing the field.  However, they also functioned both informally and surreptitiously as they kept members accountable through “intraprofessional” regulation. Writes Nye: “There was no written code that might serve as a statutory benchmark;” moreover, men who had no knowledge of the codes were unable to be admitted, a telling insight into why women were unable to be admitted as well (Nye 145). 

            With the advent of the twentieth century, the informal organization within medical societies proliferated. Though women could now gain admission to formerly all-male state schools, they were often discouraged from participating in the non-educational facets of the profession, particularly the social networking aspect. Nye notes that women’s entrance into the medical profession during the twentieth century was followed by a “hierarchy of disincentives ranging from brutal to subtle” that were informally instituted within the masculine sociability of the profession.  In Victorian terminology, the vices of alcohol, smoking and profanity were seen as essential to male solidarity, excluding women through the traditional rhetoric of difference (Nye, 148).  As a letter to the editor by the medical practitioner J.H. Crane demonstrates, Crane and a host of other practitioners deemed women to be unfit for the rigors of the medical profession. “I allow no man to go further than I do in admiration, love and esteem for female modesty…but when she steps aside and attempts a role that she is by nature physically and mentally disqualified for, she forfeits the claims of a modest woman” (J.H. Crane, “Protest Against Receiving Females as Members of the State Medical Society,” Pacific Medical and Surgical Journal 19, no. 1 (June 1876), 22). The central theme of Crane’s analysis, that female modesty is of the highest virtue for women to attain contradicts the fraternizing that comprises the core solidarity of the medical profession. Moreover, as women attempted to participate in these social functions, they often ran the risk of being subjected by their male peers to the perception of being “desexed” (Nye 149).  

            The contribution of Nye’s work to the abounding scholarship on women and medicine is crucial in that it broadens our understanding of the patterns of male modes of sociability within the medical profession. By understanding these modes of masculinity and their dominance within the medical profession, we now have a more definitive context by which to understand the causes of women’s exclusion from its ranks. 

           

Guest Post by Mycah Harrold

Strong Muscles & Strong Morals: Charles Atlas’s Aim to Develop Strongmen of Physical and Moral Purity

“A weakling, weighing ninety-eight pounds
Will get sand in his face when kicked to the ground...”-Frank-N-Furter [this and all other bold quotes from“I Can Make You A Man,” Rocky Horror Picture Show]

Angelo Sicilano became Charles Atlas after winning the ‘World’s Most Beautiful Man’ contest and used his prize money to develop a fitness plan [Elizabeth Toon & Janet Golden, “‘Live Clean, Think Clean, and Don’t Go To Burlesque Shows’: Charles Atlas as Health Advisor,” Journal of the History of Medicine 57 (2002): 42-44]. With marketing help from a young account executive, the “Dyanmic Tension” title was coined, the iconic cartoon strip-style advertisements were created and the pair found a receptive audience and much financial success [Toon & Golden, 45].

An interesting theme present in the print materials published in Atlas’s campaign is the idea of maintaining purity. Atlas’s intended audience, young men between the ages of fifteen and twenty-five, is not one that our current popular culture tends to associate with purity and wholesomeness. However, Toon and Golden report that by 1980, Atlas’s plan had reached 1.5 million people, the majority of whom were in this group [Toon & Golden, 50].

“He'll be pink and quite clean
He'll be a strong man...
He'll eat nutritious high protein and swallow raw eggs”

One particularly purifying practice this “World’s Most Perfectly Developed Man” prescribed with enthusiastic fervor was that of bath-taking. He suggested his trainees bathe daily and also preached the benefits of “cool baths, warm baths, sunbaths, and rubdowns,” “air and sun baths,” and “music baths.” Atlas also encouraged his readers to consider their “inner hygiene.” Toon and Golden explain that “Consuming natural, pure substances was a vital element in Atlas’s system.” Atlas promoted drinking pure water and milk and breathing pure air, which he believed would allow for one to have “pure blood.” However, Atlas was not just a proponent of keeping the physical body pure and clean; he was also concerned with moral purity [Toon & Golden, 48-58].

“I don't want no dissention, just dynamic tension.”

Atlas’s teachings have been compared by Toon, Golden and others to the advice given by Emily Post. He encouraged his readers to be cheerful and to engage in “‘light, sociable conversation on pleasant topics’ (lesson 2)” during dinner. Atlas also offered advice to curb any “lack of sexual control” they may have experienced and urged them to sacrifice “temporary pleasures” to benefit their own purity. He identified “will power as the primary key to overcoming such habits.” It seems Atlas was implying that having strong muscles and strong morals were powerfully intertwined [Toon & Golden, 52-57].

“Seal of Approval”

In 1975, toward the end of Charles Atlas’s peak and a few years after the man’s death, the movie musical The Rocky Horror Picture Show made its debut in America. In the story, unorthodox “scientist” Frank-n-Furter has created his own Muscle Man, Rocky [The Rocky Horror Picture Show, directed by Jim Sharman (1975; Berkshire, England: Twentieth Century Fox Film Corporation, 2002), DVD]. Two songs- “I Can Make You A Man” and its reprise- are rife with allusions to Charles Atlas and imply that Rocky is a similar being. Rocky, while exemplifying the other traits Atlas’s followers would be aspiring to, was the epitome of purity. He was created as such and, as Frank-N-Furter makes clear in his songs, will be adhering to the Charles Atlas way of life and remain pure. Frank-N-Furter even claims that his creation “carries the Charles Atlas Seal of Approval” [The Rocky Horror Picture Show]. While it may be surprising in this day and age to imagine a popular public body-builder endorsing regular baths and polite dinner conversation, or bodily and moral purity, Charles Atlas did just that for the fifteen to twenty-five year old men who made up his intended audience. Rocky Horror, in his own purity and commitment to the Dynamic Tension system, was second only to ‘the World’s Most Beautiful Man” [Toon & Golden, 42].