Invalid Women

Figuring Feminine Illness in American Fiction and Culture, 1840-1940

Diane Price Herndl

• Publisher: The University of North Carolina Press
• Year: 2000
• ISBN:
  9780807863909
• Topic: Literature
• Subtopic: North American Literary Criticism
• Index: Literature

"A fine example of politically engaged literary criticism.-- Belles Lettres "Price Herndl's compelling individual readings of works by major writers (Harriet Beecher Stowe, Hawthorne, Wharton, James, Fitzgerald) and minor ones complement her examination of germ theory, psychic and somatic cures, medicine's place in the rise of capitalism, and the cultural forms in which men and women used the trope of female illness.-- Choice "A rich and provocative study of female illnesses and their textual representations.... A major contribution to the feminist agenda of literature and medicine.--Medical Humanities Review "[An] important book.-- Nineteenth-Century Literature "[This] sophisticated new study... brings the best current strategies of a thoroughly historicized feminist literary criticism to bear on textual representations of female invalidism.-- Feminist Studies "An outstanding study of the representation of female invalidism in American culture and literature. There emerges from this work a striking sense of the changing meanings of female invalidism even as the conjunction of these terms has remained a constant in American cultural history.... Moreover, Invalid Women provides fascinating readings of female illness in a variety of texts.--Gillian Brown, University of Utah "A provocative study based on imaginative historical research and very fine close readings. The book provides a useful American complement to Helena Michie's The Flesh Made Word and Margaret Homans's Bearing the World. It should prove enlightening and otherwise useful not just to scholars of American literature, but also to those engaged in American studies, feminist criticism and theory, women's studies, the sociology of medicine and illness, and the history of science and medicine.--Cynthia S. Jordan, Indiana University

Chapter 1
Defining the Feminine/Defining the Invalid

Women and Medicine in the Mid-Nineteenth Century

It is the verdict of women which decides the fortunes of a doctor.

—S. Weir Mitchell, A Comedy of Conscience (1903)

In 1855, Catharine Beecher (sister of Harriet Beecher Stowe and an advocate of female health reforms) declared in Letters to the People on Health and Happiness that female illness was increasing so rapidly that “ere long, there will be no healthy women in the country” (9). In an informal survey that she conducted in 1866, respondents from across the United States reported such numbers of ill women that Beecher concluded, “The more I traveled, and the more I resided in health establishments, the more the conviction was pressed on my attention that there was a terrible decay of female health all over the land, and that this evil was . . . increasing in a most alarming ratio” (quoted in Gail Parker, The Oven Birds, 165). William Dean Howells remarked in 1872 that American society “seems little better than a hospital for invalid women” (quoted in William Wasserstrom, Heiress of All the Ages, 135). Another writer, reviewing The Effect on Women of Imperfect Hygiene of the Sexual Function (1882), wrote, “Three of every four married women suffer from sexual ill-health due to ignorance before and after marriage” (ibid., 12). Today many historians recognize the epidemic proportions of nineteenth-century women’s “illnesses”; Robin Haller and John Haller have dubbed it the “nervous century,” and medical historians Vern Bullough, Martha Voght, Martha Verbrugge, Carroll Smith-Rosenberg, and Charles Rosenberg have all pointed to the widespread cultural acceptance of women’s innate unhealthiness.

The causes of such alarming reports of ill health are not only uncertain today but were the subject of heated debate at the time. The theories put forward by nineteenth-century doctors to explain illness among women were more than inconsistent; they were downright contradictory. Even when physicians practiced the same kind of medicine (and there was much more heterogeneity of medical care than there is today), they often disagreed as to what was causing the widespread collapse of feminine health. Some physicians saw illness as the result of moral and sexual decay; some held that sex education increased sickliness, while others saw sexual ignorance as the root of much illness. Some doctors, like Edward H. Clarke, contended that women’s increasing education weakened their bodies by strengthening their minds, but others maintained that the boredom of too little education left women prey to disease. Illness was believed to be both woman’s lot because of her feminine role as a mother and her lot when she violated the feminine role and refused motherhood. Today we are still unsure of the exact causes of women’s ill health during the nineteenth century and unsure how widespread this “illness” was; many of the diseases diagnosed then are no longer recognized as “real” diseases today or are recognized as psychosomatic or psychological afflictions about which the nineteenth-century physician would have been ignorant. In her controversial article “‘The Fashionable Diseases’: Women’s Complaints and Their Treatment in Nineteenth-Century America,” Ann Douglas Wood argues that women of the nineteenth century may have been no more unhealthy than their eighteenth-century mothers and grandmothers but learned to think of themselves as unhealthy (27).

The sickly woman emerged as a figure in American society just as the sickly woman became a predominant literary figure. There have, of course, always been ill, suffering, and dying characters in literature, and many of them have been women, but in the mid-nineteenth century, the female invalid became a standard feature of much American fiction.¹ In fact, one of the first novels published in America by an American author, Susanna Rowson’s Charlotte Temple (1794), features a woman who is betrayed by her lover, falls ill, and dies. In the 1840s, however, in magazine fiction, novels, biographies, and religious tracts,² the figure of the sickly woman gained new prominence. One could argue that such fiction merely reflected the reality of the times, but such a view assumes that there is an easily recoverable “reality” with which to compare the fiction. Instead, we have contradictory and polemical accounts of the nineteenth-century “realities” of women’s health. Some recent studies, like Martha Verbrugge’s Able-Bodied Womanhood and Frances B. Cogan’s All-American Girl, even question whether invalidism was ever the widespread phenomenon that other historians have claimed it was. Whatever the “true” statistics on real women, however, their literary counterparts dropped like flies. Given the power of literary representation, such cultural figures may well have, in part at least, caused such alarms.

There are a number of reasons why women might have been genuinely more sickly in the nineteenth century than in other centuries; social and sexual conventions, dress styles, dietary and exercise regimes had changed in ways that left women repressed, confined, sedentary, and often malnourished. These changes in life-style, however, were not drastic enough to explain entirely the emergence of sickliness as a cultural and literary figure at mid-century. Nor do they address Ann Douglas Wood’s supposition that women were suffering from diseases that were as much fashionable as pathological. If we understand that many women’s illnesses of the late nineteenth century could have been “fashionable diseases,” that is, culturally accepted, expected, and even culturally induced, then we begin to understand how language and literature can have shaped women’s experiences of their bodies.

The figure of women’s failing health arises from a specific conflict over women’s “proper role” in the 1840s. At the same time that women—guided by the tenets of domestic ideology—were asserting their increasing importance in the household and feminists were beginning to argue for their rights as political and social equals, physicians, seeking to improve their economic and professional standing, were asserting women’s weakness and innate unhealthiness. Meanwhile, the urbanization of the United States and the shift to industrial capitalism were changing the relationships between men and women and between people and their work. Men were increasingly expected to leave the household to earn their living and to depend on women to run the household amid the changing technologies of housework. The result was a dynamic struggle among competing ideologies to define gender roles (for both sexes) and to gain control of people’s bodies. Increasingly, this conflict became a struggle to define women’s bodies as sickly; even so, not all definitions of woman as invalid meant the same thing, nor did they come from the same motivation. To better understand this conflict, we must first examine the history of women’s health and health care in the nineteenth century.

Women’s Health in the Mid-Nineteenth Century

Late twentieth-century physicians and historians understand nineteenth-century women’s ill health better than did contemporary physicians. Even though we cannot know the causes and exact nature of the diseases with certainty, we recognize today that American society was peculiarly equipped to encourage sickness. The cultural norms for women encouraged frailty and delicacy; robust health was thought to be the working woman’s mark, not the leisured lady’s. The middle-class woman was encouraged from childhood to view herself as weaker and less healthy than her brothers. When she entered adolescence, if she was taught about her monthly cycle at all, she was taught that it would be debilitating and leave her prone to nervous attacks. As an adult, she was to be the symbol of her husband’s status, to do no work, and to be beautiful and feminine, that is, frail and delicate. The working-class woman, no matter the real state of her health, had no choice in the matter; she had to continue working, despite illness, to feed her family. As Lorna Duffin explains in “The Conspicuous Consumptive,” “Middle-class women in the home were pure but sick; working-class women outside the home were able-bodied but contaminated and sickening. This classification further reinforced the boundary between home and work within the context of sex” (31). But even modern historians of women’s health have had some difficulty explaining and accepting the power of the nineteenth-century stereotype. For every theory we come up with, there is a corresponding countertheory. In many ways, our understanding of the history of women’s health is just as conflicted and contradictory as were nineteenth-century theories.

Twentieth-century people tend to think of the history of health and health care in terms of progress, assuming that there has been a steady are upward since the Dark Ages in terms of medical treatments. When confronted with a claim that antebellum American women were, or saw themselves as, unhealthier than their eighteenth-century counterparts, we do not accept it easily. One response is to follow Ann Douglas Wood’s argument in “‘The Fashionable Diseases’” that such diseases were just “fashionable” and that women were not really more ill. Illness was not just a fad, she argues, but “was exploited by its victims and practitioners as an advertisement of genteel sensibility and an escape from the too pressing demands of bedroom and kitchen” (27).³ Another response to the dilemma of explaining women’s declining health is to argue, as do Carroll Smith-Rosenberg and Martha Verbrugge, that female illness may well have been a response to the overwhelming social and political changes of the mid-nineteenth century, a somaticization of the “disease” of the anxiety, stress, and unhappiness women felt about the restrictions on their lives.

There are few reliable statistics about public health before about 1890, so evaluations of women’s health must be based on less reliable documents like individual case studies, diaries, letters, and published contemporary assessments. There may not have been more ill women in the nineteenth century than in other times, but only more women who were willing to think of themselves as ill and to accept the role of invalid. The statistics that do exist suggest that men’s health was just as bad as (and, based on death rates, possibly worse than) women’s. The public perception, however, was that women were truly at risk, and both popular and professional reforms of health care began to address that perception.

In colonial America, sickness had been understood as inevitable and was expected, but by the mid-nineteenth century, public attitudes toward sickness and health had changed. Martha Verbrugge documents this change during the years between 1820 and 1860 in New England and finds that people began, during those years, to believe that good health, rather than bad, should be seen as the normal condition. A new model of womanhood emerged (which Frances Cogan calls “Real Womanhood”) in which women were seen as strong, capable, and healthy. Yet another way to understand the new emphasis on feminine illness, then, would be to see it as a reaction to the ideology of “able-bodied womanhood” that was emerging; in the same way that Twiggy and other very thin models made normal women of the 1960s feel fat, the new healthy model of womanhood at mid-century may have made the average woman, by comparison, feel sickly.

The contradictory models of womanhood—the “Cult of True Womanhood” (described by Barbara Welter), the “cult of female frailty” and the necessity of “Able-Bodied Womanhood” (both described by Martha Verbrugge), and the model of “Real Womanhood” (described by Cogan)—coexisted. One need only think of Louisa May Alcott’s Little Women (1868–69) to understand that they need not be exclusive (although a historian is often inclined to argue that her own model was the chief one). Did nineteenth-century girls follow the model of the pious but doomed invalid, Beth; the strong, capable, and domestic Meg; or the rebellious, high-spirited, and robust Jo? Despite the often polemical claims of historians, no one model of womanhood fit every woman. Every nineteenth-century woman may not have believed herself an “invalid woman,” but the “cult of female frailty” was one of the dominant models of womanhood in mid-century fiction. It was, absolutely, the model adopted in mid-century writing about female health, even in texts that were written to promote reforms in health care.

There are several reasons why women’s health might have been genuinely worse in the nineteenth century than in the twentieth century and possibly even the eighteenth. First, women were very poorly informed about their bodies. Doctors knew very little about the female body or how to treat its ailments; women knew even less. The modesty encouraged by nineteenth-century social mores kept many from expressing any interest in bodily functioning and even made it difficult for physicians to find out much about the female body, since women would often refuse physical examination (Douglas Wood, “‘The Fashionable Diseases,’” 32–33). This modesty was in some cases so extreme that when physicians were taught how to deliver babies (which was not until mid-century), they were taught to do so without looking at the woman, even if they were using forceps, according to Judith Leavitt in “‘Science’ Enters the Birthing Room” (285). Peter Gay, in The Education of the Senses, disputes the widely held notion that this Victorian prudishness was established by women and argues that the standards of modesty for examining female patients may well have been imposed more by the doctors than by their clients. Gay claims that “there is good evidence that nineteenth-century women were often less squeamish than men, and that when men were squeamish in their behalf, they were protecting an ideal in their minds, suiting their own needs” (347). No matter who imposed such standards of modesty, though, there is little disagreement that they led to ignorance, on the part of both doctors and patients, and poorer standards of health care.

Pregnancy and menses had been accepted in the eighteenth century as natural, if unpleasant, events, but in the nineteenth century they came to be considered pathological conditions (Jane Donegan, “‘Safe-Delivered’ but by Whom?,” and Judith Leavitt, Brought to Bed). When women were taught about their bodies or their monthly cycles, often they were told to expect weakness, pain, and illness. S. Weir Mitchell, the doctor who treated Charlotte Perkins Gilman and William Dean Howells’s daughter Winifred and supervised the treatment of Edith Wharton, wrote in the 1880s, “We may be sure that our daughters will be more likely to have to face at some time the grim question of pain than the lads who grow up beside them. . . . To most women . . . pain is a grim presence in their lives” (Doctor and Patient, 84). Carroll Smith-Rosenberg and Charles Rosenberg, describing Victorian medical theories of women’s health in “The Female Animal,” show that many were not based on “scientific fact” but were mirrors of cultural stereotypes that assumed a woman’s health was controlled by her reproductive system: “The image granted women in these hypothetical designs was remarkably consistent with the social role traditionally allotted them. The instincts connected with ovulation made her by nature gentle, affectionate, and nurturing. Weaker in body, confined by menstruation and pregnancy, she was both physically and economically dependent upon the stronger, more forceful male, whom she necessarily looked up to with admiration and devotion” (14). Although there were a number of medical tracts to the contrary, the most widely accepted theories were those which corresponded to the cultural norms, despite the fact that there was a great variety of health and sexual information available to the Victorian reader, as Carl N. Degler explains in “What Ought to Be and What Was: Women’s Sexuality in the Nineteenth Century.” Degler provides evidence that women had access to more accurate information about sexuality than is commonly believed and reports evidence from an ongoing survey of women that shows that the numbers of “sexually ignorant” women were greatly exaggerated. But Degler does not deal with the question of why such a powerful stereotype was and has been able to co-opt the “facts.” (And though it is outside the scope of this study to answer such a question directly, my argument indirectly addresses it through the power of representations to shape reality.) Whatever possibilities were offered by alternative medical theories,⁴ mainstream medical theories did not change substantially until the culture did. As we shall see in a closer examination of one of these medical tracts, when women were provided with medical information, it was often wrong, ideologically motivated, or more frightening than informative.

A second reason for women’s poor health lies in nineteenth-century clothing styles. Almost all middle-class women wore corsets, some even into the seventh month of pregnancy. In the eighteenth century, this practice had been limited almost exclusively to wealthy women, but by the mid-nineteenth century, even serving girls who did heavy manual labor, in an attempt to elevate their apparent status, wore corsets on the job. On average, corsets reduced women’s waists by 2 to 10 inches and put from 35 to 88 pounds of pressure on the abdomen (Helen Ecob, The Well-Dressed Woman, 28, 35). One study showed that the average woman’s waist measurement was 20 inches in the 1890s and that the long, heavy, sweeping skirts that women wore with several petticoats restricted their ability to move freely.⁵ In addition, these skirts and petticoats often meant more than 15 pounds of clothing hanging from a restricted waist (Vern Bullough and Martha Voght, Women, Menstruation, and Nineteenth-Century Medicine, 35). Helen Ecob’s The Well-Dressed Woman (1892) provides convincing evidence that women’s internal organs were deformed by these practices, that their breathing was constricted, and that exercise was made all but impossible. The dress reform movement caught on slowly (feminists and physicians, in a rare alliance, argued for dress reform as early as the 1840s), but improvements in women’s clothing did not occur until the early 1900s.

Third, women’s diet, exercise, and basic hygiene were sometimes neglected. As industrialization and urbanization increased, middle-class women were given more freedom from physical labor than women had ever experienced and their lives became sedentary as a result. Further, working under the theory that spicy, rich foods and exercise excited girls to masturbation and other sexual infelicities, doctors and parents sometimes deprived girls of protein and physical activity, which resulted in anemia and emotional disturbances that lasted well into their adult years (Bullough and Voght, Women, Menstruation, and Nineteenth-Century Medicine, 34). In Women and Economics (1899), Charlotte Perkins Gilman devotes much energy to diet and exercise reform, as did many other feminist reformers in the late nineteenth century, especially women physicians.⁶ After a number of years, the reformers were finally persuasive; in the early decades of the twentieth century, there was an enormous upsurge of interest in exercise for girls and w...

Table of contents

• Cover Page
• Invalid Women
• Copyright Page
• Dedication
• Contents
• Illustrations
• Preface
• Introduction
• Chapter 1 Defining the Feminine/Defining the Invalid
• Chapter 2 The Threat of Invalidism
• Chapter 3 (Super) “Natural” Invalidism
• Chapter 4 The Writing Cure
• Chapter 5 Fighting (with) Illness
• Chapter 6 Economies of Illness
• Conclusion: Invalidism and the Female Body Politic
• Notes
• Bibliography
• Index