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“THE SACRED DOMAIN”: WOMEN AND THE TRANSFORMATION OF GYNECOLOGY AND OBSTETRICS IN THE UNITED STATES, 1870-1920 by CARRIE PAULINE ADKINS A DISSERTATION Presented to the Department of History and the Graduate School of the University of Oregon in partial fulfillment of the requirements for the degree of Doctor of Philosophy December 2013 DISSERTATION APPROVAL PAGE Student: Carrie Pauline Adkins Title: “The Sacred Domain”: Women and the Transformation of Gynecology and Obstetrics in the United States, 1870-1920 This dissertation has been accepted and approved in partial fulfillment of the requirements for the Doctor of Philosophy degree in the Department of History by: Ellen Herman Chairperson James Mohr Core Member April Haynes Core Member Elizabeth Reis Institutional Representative and Kimberly Andrews Espy Vice President for Research and Innovation; Dean of the Graduate School Original approval signatures are on file with the University of Oregon Graduate School. Degree awarded December 2013 ii © 2013 Carrie Pauline Adkins iii DISSERTATION ABSTRACT Carrie Pauline Adkins Doctor of Philosophy Department of History December 2013 Title: “The Sacred Domain”: Women and the Transformation of Gynecology and Obstetrics in the United States, 1870-1920 This dissertation contends that women – as intellectuals, educators, physicians, activists, consumers, and patients – shaped the dramatic transformation that took place in the medical specialties of gynecology and obstetrics in the late-nineteenth- and early- twentieth-century United States. These two specialties were particularly contentious because they were inextricably linked with social, cultural, and political ideas about gender, race, class, sexuality, reproduction, and motherhood. In the resulting climate of chaos and controversy, women themselves played the key roles in resolving medical debates about their bodies. Furthermore, their work had a much broader significance: as women altered medical approaches to female bodies, they influenced a larger discourse about the meaning of normal femininity and the nature of American womanhood. This project is not an institutional history of gynecology and obstetrics but, instead, serves as a social and intellectual history of these specialties. It features women as primary actors and emphasizes significant connections between medical perceptions of women’s bodies and social constructions of women’s lives. By examining several key issues in these specialties – medical constructions of menstruation, controversies over women’s medical education, the contested evolution of surgical gynecology, and the iv development of prenatal care and obstetric anesthesia – it demonstrates that the physical body served as a battleground for the ideological construction of women in society. As women worked from inside and outside the medical community to define what it meant to have a healthy, normal female body, they also constructed larger visions of what it meant, fundamentally, to be a healthy, normal American woman. v CURRICULUM VITAE NAME OF AUTHOR: Carrie Pauline Adkins GRADUATE AND UNDERGRADUATE SCHOOLS ATTENDED: University of Oregon, Eugene Tulane University, New Orleans, Louisiana DEGREES AWARDED: Doctor of Philosophy, History, December 2013, University of Oregon Master of Arts, History, June 2010, University of Oregon Bachelor of Arts, History, June 2007, University of Oregon AREAS OF SPECIAL INTEREST: Social History of Medicine History of Women, Gender, and Sexuality PROFESSIONAL EXPERIENCE: Graduate Teaching Fellow, University of Oregon, 2008-2013 GRANTS, AWARDS, AND HONORS: Oregon Humanities Center Dissertation Fellowship, University of Oregon, 2013 Foundation for Women in Medicine Fellowship, Countway Library, 2012 M. Louise Carpenter Gloeckner, M.D., Summer Research Fellowship, 2012 Western Association of Women Historians Graduate Student Paper Prize, 2012 Colonial Dames of America American History Education Award, 2011 University of Oregon Graduate Student Research Award, 2011 Department of History, University of Oregon, Thomas T. Turner Award, 2010 vi ACKNOWLEDGMENTS I am tremendously grateful to my advisor, Ellen Herman, who guided me through each stage of graduate school and supported this project from its inception. The three other members of my dissertation committee were also extremely helpful: James Mohr provided important insights about medical history and scholarly writing, April Haynes suggested crucial readings on gender and the body, and Elizabeth Reis offered thoughtful, constructive, and enthusiastic advice on the entire dissertation. Over the past five years, I have also benefited from the friendship and encouragement of many of my fellow graduate students in the Department of History at the University of Oregon, especially Feather Crawford, Nathan Jessen, Hillary Maxson, Alison Robert, Adam Turner, and Camille Walsh. This project was supported, in part, by grants and fellowships from the Foundation for Women in Medicine, Drexel University’s Archives and Special Collections on Women in Medicine, the Colonial Dames of America, the Oregon Humanities Center, and the University of Oregon Graduate School and Department of History. I am grateful to the archivists and support staff at all of the institutions cited in the dissertation. Special thanks are due to the amazing staff at Drexel’s Legacy Center, particularly Matt Herbison, archivist extraordinaire. I owe an additional debt of gratitude to my colleagues at Nursing Clio, the collaborative blog project I co-founded in 2012. Jacqueline Antonovich, Cheryl Lemus, Ashley Baggett, and (again) Elizabeth Reis and Adam Turner, especially, have been constant sources of advice and commiseration. vii On a more personal level, I want to thank my brother, Thom Scher, and my sister, Laura Romero, for their love and encouragement. My father, Bruce Scher, passed away before I finished writing the dissertation, but he believed in me and in the project, and I will always be grateful for that. My children, Jackson and Sam, have, for just about as long as they can remember, put up with a mother who has to work on weekends and travel for research and conferences, and they do not seem to hold it against me. Finally, there are no words to adequately convey how much I owe to my husband, Matt Adkins, to whom this project is dedicated. I truly could not have done it without him. viii For Matt, obviously, always. ix TABLE OF CONTENTS Chapter Page I. INTRODUCTION .................................................................................................... 1 Early Origins: The Birth of Gynecology and Obstetrics as Medical Specialties .............................................................................................................. 5 Historiography and Methods .................................................................................. 19 Sources ................................................................................................................... 25 Organization ........................................................................................................... 27 II. “A FAIR CHANCE”: MENSTRUATION, EDUCATION, AND THE PHYSICAL CAPABILITIES OF LATE-NINETEENTH-CENTURY AMERICAN WOMEN ................................................................................................ 33 Edward H. Clarke and Late-Nineteenth-Century Social Anxieties ....................... 41 Edward H. Clarke and Late-Nineteenth-Century Medical Science ....................... 46 Discrediting the “Gloomy Little Specter, Edward H. Clarke” ............................... 50 Rejecting the Pathology of Femininity .................................................................. 55 Perspective and Priorities: The Consequences of Rejecting Edward H. Clarke .... 69 III. TRAINING “WOMANLY WOMEN”: GENDER, CLASS, AND THE DEVELOPMENT OF MEDICAL EDUCATION FOR WOMEN ............................. 74 Gender, Class, and Opposition to Women in Medicine ......................................... 81 What Should Women’s Medical Education Look Like? ....................................... 97 How Should Female Medical Students and Women Physicians Look and Act? ....................................................................................................................... 105 Obstetrics, Gynecology, and New Definitions of Healthy Womanhood ............... 113 x Chapter Page IV. “THERE IS NOT SUCH SPECIAL SANCTITY ABOUT THE OVARY”: SURGICAL GYNECOLOGY AND THE CONSTRUCTION OF HEALTHY FEMININITY .............................................................................................................. 121 Radicals, Conservatives, and Surgical Gynecology .............................................. 126 Surgical Gynecology and Healthy Options Outside of Marriage and Motherhood ............................................................................................................ 138 Consequences of Female Support for Surgical Gynecology ................................. 145 Feminist Surgical Gynecology ............................................................................... 155 Gender, Power, and Radical Gynecology .............................................................. 158 V. “IF YOU WOMEN WANT IT YOU WILL HAVE TO FIGHT FOR IT”: THE REVOLUTION IN EARLY-TWENTIETH-CENTURY OBSTETRICAL CARE ........................................................................................................................... 162 The Development of Standardized Prenatal Care .................................................
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