The Doctor Wore Petticoats: Women Physicians of the Old West

by Enss, Chris

  AT THE AGE OF TWELVE, SUSAN LA FLESCHE BEGAN TO IMAGINE HERSELF AS A DOCTOR, AND BY THE TIME SHE WAS TWENTY-FOUR SHE HAD BECOME THE FIRST FEMALE NATIVE-AMERICAN PHYSICIAN.

  Susan spent the remainder of the evening hopelessly trying to make the woman comfortable. The agony of the lady’s unknown affliction continued until the morning. By the time the sun had fully risen, the woman had passed away. Susan stood over the lifeless body, contemplating the tragedy and deciding her own course of action. If she were a doctor, she would respond quickly to Indians in need of medical attention. Their lives would matter to her.

  Such were the circumstances surrounding Susan’s initial interest in medicine. After witnessing the old woman’s agony, she resolved to “serve others, visit the poor, and help the suffering humanity.”

  Susan La Flesche was born in June of 1865, the youngest daughter of Omaha Indian Chief Joseph La Flesche and his wife, Mary. Susan, her three older sisters, and two brothers were raised to generously give of themselves to those in need.

  At the insistence of her parents, and like her siblings before her, Susan took full advantage of the “white education” offered to children on the reservation. The focus of the white missionaries who ran the school was to transform the seemingly wild Indian into a respectable citizen of the United States. Susan would allow them to teach her new ways, but would never fully abandon the traditions in which she was raised. According to Susan’s journal, “the old ways are not devoid of values, culture, and emotional ties, and need always to be preserved.”

  Chief La Flesche instilled many values in Susan and her brothers and sisters. He was a farmer, and his children worked alongside him as they grew up. Susan’s jobs varied throughout the seasons. In the spring she sowed corn, hoed potatoes, and weeded. In the fall she lent a hand with the harvest. Throughout the year she foraged wood, tended to the livestock, dressed animal skins, dried bison meat, and carried water to the camp from a nearby stream. With few exceptions Susan’s childhood was idyllic. The United States government’s attempt to rid the Omaha people of their “Indianness” was the only major difficulty she faced in her younger years.

  Susan excelled in school and was often hailed by her teachers as an “exceptional student with massive potential.” At the age of fourteen, with her eyes fixed on a career in medicine, Susan persuaded her parents to allow her to further her learning at the Elizabeth Institute for Young Ladies in New Jersey. Susan’s sister had attended the school some years prior and was now a teacher on the reservation. Believing Susan would receive a better education at the institute, Joseph agreed to let her go.

  Susan remained at the school for two and a half years. In addition to courses in English, Latin, literature, and music, she took on a number of college preparatory classes. The time she spent at the institute gave her a cross-cultural understanding that further enhanced her education. She returned to the reservation in 1882, a well-rounded seventeen-year-old with a greater knowledge of the government and the people seeking control of the Omaha Nation. Her goal now was to not only become a physician, but to be an advocate of Indian rights. Susan would learn from her father how best to politically serve the Omaha people.

  Under Chief Joseph’s leadership, the tribe was negotiating with Congress to remain on their ancestral homeland. Joseph needed the support of his well-educated children to help him through the process. Eventually, a land allotment agreement between the United States government and Native Americans temporarily halted the Omaha Indians from being pushed out of the territory. It would prove to be a short-lived victory. Susan celebrated the triumph with her family, unaware of the extent to which politicians would attempt to Americanize the Indians.

  When Susan wasn’t at home with her parents, she was working at the school on the reservation. The Presbyterian missionaries who ran the facility made a huge impression on her life. She wholeheartedly embraced their religion and accepted a position as a teaching assistant.

  Susan enjoyed the experience, but her ambition did not lie in teaching. She left the school six months into the first semester and took a job as a nurse for an ill ethnologist. The woman was bedridden and suffering with inflammatory rheumatism. After five weeks Susan had helped restore the scientist’s health. The woman was so grateful for Susan’s efforts she provided partial funding for her to attend a school in Virginia and then to continue on to the Women’s Medical School in Philadelphia.

  In the fall of 1883, Susan once again left her family and tribe. Before she left, she promised her people that she would return and work among them as their physician.

  A note in her journal capsulated her thoughts on the journey she was about to make: “I will come from the tepee to civilization.”

  Susan encountered people from all walks of life at the Hampton Institute in Virginia. She shared a variety of classes such as philosophy, piano, and art, with fellow Native Americans and black, ex-slave students from across the country. Her extracurricular activities included skating, playing tennis, and working with the Lend-A-Hand Club. The club collected gifts for the poor, visited the sick, and taught Sunday school.

  Susan’s daily routine began at 5:30 A.M. After chores and calisthenics, she would dress in a dark calico and muslin uniform, have breakfast in the cafeteria, and report to class by 9:00 A.M. Her studies continued until the evening meal was served at 6:00 P.M. Prayers in the chapel followed the meal, after which Susan would study until bedtime at 9:30. During the summer months, Susan taught school to underclassmen. The Federal Government strongly encouraged Indian women who wanted a career to consider teaching. But Susan had other plans.

  A few months before graduating from the Institute, she applied and received acceptance into the Women’s Medical College in Pennsylvania. Before making the trip to Philadelphia, she recalled the encouraging words of her father to her and her sisters when they were growing up:My dear young daughters, do you always want to be simply called those Indians or do you want to go to school and be somebody in the world? From that moment I determined to make something useful of my life.

  Susan’s decision to enter the field of medicine met with opposition from the public at large. They found it unseemly that women should be in the profession at all, and particularly objected to an Indian woman in medicine. Susan faced criticism from the Omaha people as well. Indian women could become healers, but only after menopause. Native Americans believed that women were a spiritual danger to the tribe if they practiced healing anytime prior to that.

  Funding for Susan’s college education came from the Women’s National Indian Association (WNIA). Many government agencies were against financially supporting Indian women seeking a higher education. They felt Native-American women should return to the reservation and assume their traditional roles.

  Those in favor of Indian women in medicine, like the WNIA, argued that with medical knowledge and skills, Indian women could protect their homes, tribe, and families. Susan was in agreement with the WNIA, and when they asked for her thoughts on the matter, she expanded on their ideals:As a physician I will help the Omahas physically, teach them the importance of cleanliness, order, and ventilation, how to care for their bodies as well as care for their souls.

  Susan entered the Women’s Medical College in Philadelphia in October of 1886. The heavy course load for her first semester consisted of classes in chemistry, anatomy, obstetrics, and general medicine. In addition to her class work, she observed clinical practice at the women’s hospital, took weekly examinations in all her subjects, and learned how to dissect the human body. Other women had trouble with dissections, but Susan did not mind the procedure:The students and I laugh and talk up there just as we do anywhere. Six students take one body . . . and [it] is divided into six parts. Two take the head . . . two the chest . . . two the abdomen and legs. Then we take off little by little. . . . It is interesting to get all the arteries and the branches. Everything has a name . . . from the little tiny holes to the bones. It is splendid.

  Susan frequ
ently sent letters home to her family in Nebraska, updating them on her studies. She bragged about the excellent teachers at the medical college and how fortunate she was to benefit from their wealth of knowledge. Surgeons often allowed medical students to watch them perform an operation, which provided Susan and the other students with a more in-depth way of learning.

  After three years of hard work and examinations, Susan graduated. She was first in her class. When she accepted her medical diploma in August of 1889, she became the first Native American woman doctor in the United States.

  It had been five years since Susan had left home, and she was anxious to return to Nebraska. Upon her arrival, she found her parents’ health failing and the farm in disrepair. She immediately set to work bringing order to the homestead and treating her elderly mother and father. In an 1889 letter to a friend in Philadelphia, Susan wrote about her struggles and extolled the virtues of her western roots:I can tell you one thing and that is a Western woman has to know how to do everything that a man does besides her own work, for she has to be ready for any emergency that may occur when men are not around.

  Throughout the summer Susan balanced household, field, and medical work. She cooked, sewed, measured land for a fence, pitched hay, harnessed horses, and, of course, nursed the sick. At the end of that long, hot season, a severe measles epidemic swept through the reservation, killing hundreds. Had the Omaha Indians trusted western medicine, Susan could have saved many of those lives. The tribe’s people who did agree to be treated did so only after they witnessed Susan ingesting the medication herself.

  The Indians lived miles away from one another, causing Susan to sometimes travel more than 25 miles between patients to make house calls. She was committed to the tribe and would go to great lengths to bring them medical care and any other assistance they needed. In 1889, she wrote:If one wants to make a difference they must go out everyday. So much can be done by going to see them and while you are there tell them how to tidy up or show them how, which is better. These Omahas need help in many aspects of life . . . business, land, money, and horses, what kind to buy and all.

  Doctor La Flesche stood several inches shorter than most of her patients, but her medical capabilities made a tall impression. The vigilant care she gave members of the Omaha Nation instilled a sense of trust in the Indians, and her practice grew. Her reputation as a quality physician spread beyond the reservation, and, as a result, many whites as well as Native Americans sought her counsel. At one time she had a patient list of more than 1,200 people. “My office hours,” she told her friends and family, “are any and all hours of the day and night.”

  In an average day, Doctor La Flesche’s services to the public might include delivering a baby, stitching up a wound, negotiating business agreements between family members, writing a letter for an illiterate man, and paying a visit to bedridden patients on the far side of the reservation.

  Once Susan’s practice was well established, she began accepting speaking engagements at her former schools in both Virginia and Philadelphia, sharing her experiences as a doctor on the western plains with captivated audiences. Government officials in attendance were moved by her personal testimony and influence with the Omaha Nation. They encouraged the powers-that-be at the Office of Indian Affairs to appoint Susan as the chief physician to the government boarding schools for Native Americans. She accepted the post, and in a short time transformed the dismal sanitary conditions at the facilities into safe, hygienic environments.

  No matter what offices Susan held in addition to that of doctor for the Omaha reservation, she remained most concerned about her fellow tribesmen. In 1890, a large percentage of the Omaha population was suffering from a highly contagious eye disease. Susan directed all her efforts to battling the epidemic. She isolated the infected patients from the rest of the tribe and instructed all of the Indians to use separate towels and washbasins. Lack of clean water made the road to recovery a long one, but eventually the tribe’s health was restored. Doctor La Flesche’s vigilance kept the death rate low during outbreaks of influenza and tuberculosis as well.

  By 1892, Susan’s hectic work schedule and the strain of caring for her ailing mother (her father had passed away in 1888) were taking a toll on her physical well-being. Since she had been a small girl, she had suffered with a painful and degenerative bone disease that affected her inner ear. The long hours she kept and the many miles she traveled to see patients exasperated the problem until she collapsed. After several months of bedrest, Susan went back to work, but it only temporarily. Her mother’s declining health forced her to resign her position as reservation doctor so she could care for her full time.

  For the first time in twelve years, Susan’s focus was on bettering the health of two people as opposed to hundreds. Just as she was settling into a semi-retired lifestyle, she met a man and fell in love. Henry Picotte, a Sioux Indian from South Dakota, was a farmer and a divorced father of three. Historians report that Henry was a “handsome man with polite, ingratiating manners and a happy sense of humor.” Susan and Henry were married on June 30, 1894.

  The Picottes moved to a quaint house in Bancroft, Nebraska. Three weeks after they exchanged vows, Susan began seeing patients in a makeshift office in the living room of their home. Within a year of reopening her practice, she succumbed to the same illness that had plagued her earlier. Her condition was further complicated by the fact that she was now expecting her first child. In spite of her poor health, she managed to carry the baby to term. The birth left her physically weak, but her spirits were strong. Henry and Susan named their eight-pound son Caryl. “He has thick black hair, and his brilliant black eyes follow us all over the room,” Susan wrote in her journal.

  Once Susan was back on her feet, she returned to her medical practice. Caryl would play in the same room where she examined her patients, and he accompanied her on house calls as well. Susan noted in her journal that Henry was a supportive husband and would often take care of their son when she had to travel great distances to visit the sick.

  In early 1898, the Picottes added another member to their family when Susan gave birth to another boy. They named this son Pierre. Despite the strain of motherhood, Susan continued practicing medicine.

  Throughout the course of her lengthy career, Susan never lost sight of the main reason she initially entered the field of medicine. She remained dedicated to improving health conditions for the Omaha people. When her practice first opened, she achieved that goal by tending to healthcare needs; later in her life, she strived to make things better by way of legislation.

  Troubled by the increasing number of Indians who had become addicted to alcohol, she appealed to the Commissioner of Indian Affairs to help deal with the impact the disease was having on adults and children alike. In her 1900 letter to Commissioner William A. Jones, she wrote:For four years, from 1889 to 1893, I worked among the Omahas. . . . At first I went everywhere alone . . . and felt perfectly safe among my people. But intemperance increased until men, women, and children drank; men and women died from alcoholism, and little children were seen wandering the streets of the towns.

  Susan explained to Commissioner Jones that men were using the money they earned from leasing their land to the government to buy liquor. “They only buy whisky,” Susan wrote, “no machinery for their farms, no household improvements are made, and complete demoralization prevails.”

  In 1901 Doctor La Flesche Picotte made an impassioned plea for help to a grand jury in the fight against the sad toll whisky was having on the Omaha people. She cited many examples of Native Americans dying as a result of alcohol. “We are a very moral people,” Susan insisted, “torn apart by the white man’s poison.” She urged the court to “take action before the tribe declined to nothing.”

  The issue of alcoholism was also a personal one for Susan. Her beloved Henry died in 1904, as a result of tuberculosis and heavy drinking. She demanded from politicians the vigorous prosecution of the law that prohibited the sale
of liquor by both non-Indians and Indians on all reservations. Inadequate funding and a shortage of enforcement officials, however, made that next to impossible to uphold.

  In spite of the problems, Susan stood firm in her crusade against “spirited drink.” By 1907, Susan could finally see the results of the attention she and others had brought to the issue of excessive drinking. In a follow-up letter to the Commissioner of Indian Affairs, she wrote that the Omaha people “were drinking much less, working better, and beginning to get interested in church.”

  When Doctor Susan La Flesche Picotte wasn’t acting as a spokesperson for the Omahas and working for the economic, social, and spiritual advancement of Native Americans, she was serving on various medical boards in the area and was the health inspector for the reservation schools. She also helped raise money to build a hospital on the reservation. On January 10, 1913, construction on the Omaha hospital was complete. A dedication ceremony was held and Susan was credited for making the dream of such a facility a reality.

  By the end of 1913, Susan’s health was again questionable. The surgery she had the previous year to help alleviate the pain in her ears had left her with a paralysis of facial muscles and a “nervous condition.” She was later diagnosed with bone cancer and underwent a series of operations to remove the infected areas.