Dr. Mutter's Marvels

by Cristin O'keefe Aptowicz

  Unskilled factory operatives, coal heavers, shipyard workers, and carpenters were paid less than a dollar a day to work fourteen hours a day, six days a week. Most factories recognized only the Fourth of July as a holiday, and vacation and sick time were, of course, nonexistent.

  Men had to compete not only with each other for these backbreaking jobs, but with children as well. In a time before laws prohibited child labor, factory and mill owners were happy to put even the youngest children to work. In one dramatic case, the Dyottville Glass Works near Kensington employed 300 people in its industrial plant. Of those 300 employees, 225 were boys, “some not yet eight years of age.”

  Young girls were not exempt from the furious maw of factory work. The area’s matchstick factories in particular sought them out, paying a wage of $2.50 a week. The girls happily took the work to help keep food on their families’ tables, having no idea, of course, that they were being slowly poisoned by the factories’ dangerous chemicals. The girls worked long hours in poorly ventilated rooms, licking their own chemical-coated fingers often to help in processing so many small slivers of wood, so difficult to see and keep track of in the dark factory setting. And what would start out as simply toothache and painful swollen gums would swiftly evolve into rotting tissue. Soon the girls’ jaws were covered with large weeping abscesses so deep, the bone could be seen and the wound would unremittingly leak a foul-smelling discharge.

  Woman with Ulcer of the Cheek

  The condition became so common it would eventually earn a nickname: phossy jaw (phosphorus being the active ingredient in matches during the mid to late nineteenth century). And if the slow disfigurement (with accompanying brain damage and inevitable organ failure) weren’t horrific enough, the chemicals the workers ingested daily caused the exposed jawbones of these now-deformed girls to glow greenish white in the dark.

  Despite all the advancements of the time, the medical profession simply could not keep up with the increasingly deadly health challenges that this newly industrialized city presented. And one of its largest failings was in women’s health.

  CHAPTER TWELVE

  THE WORLD TO COME

  THE PHYSICIAN MUST BE A CHARITABLE MAN

  Every practitioner will tell you that he daily gives up a large portion of his time to cases from which he cannot possibly derive the slightest pecuniary reward.

  But I would not confine the charity of a physician to the mere giving of alms; no, there is a charity far more precious than this, the charity of the heart.

  The kind expression, the sympathizing tear, will often convey more solace, more heartfelt and permanent satisfaction, than if we poured all the gold of Ophir into the lap of our suffering patient.

  It is this charity which “covereth a multitude of ills,” which will secure to him the widow’s love, the orphan’s prayer, the poor man’s blessing, that the physician should chiefly cultivate.

  THOMAS DENT MÜTTER

  Even in a brutal city like Philadelphia, where young men were killed daily under the crushing boot heels of the industrial age, women could still be expected to die first. And the reason for their shorter life expectancy was as common as it was heartbreaking: childbirth.

  Babies were delivered at home, with or without the help of trained midwives or doctors, with or without clean water or heat. Bringing life into the world was a dangerous prospect, and one that American woman entered into often: Women gave birth to an average of seven children in their lifetime. The statistics only get more sobering from there: One in every two hundred births resulted in the death of the mother; one in every four births resulted in the death of the infant.

  In the mid-nineteenth century, women had almost no reliable way of avoiding getting pregnant barring complete abstinence. It is no wonder that the religious group known as the Shakers—which prohibited all sexual activity among its congregation and had been led by “Mother Ann” Lee, a woman whose youth was plagued by difficult pregnancies and who lost every single one of her children shortly after giving birth to them—was steadily growing in popularity.

  The only forms of birth control available at the time, such as animal-skin condoms, which were rinsed and reused, were primitive and largely ineffective. It would be over a century before hormonal birth control would be invented.

  During this time in history, menstrual cycles were often irregular, or absent altogether, thanks to any number of factors, including attacks of common diseases, periods of malnutrition, physical stresses on the body, and/or a recent pregnancy. Oftentimes, the earliest moment a woman could be certain she was pregnant was the first time she could feel the baby stirring in her womb—an event called the quickening.

  The importance of the concept of the quickening during this era cannot be overstated. Nineteenth-century philosophers and theologians who followed the beliefs of the Christian West accepted the concept of “delayed animation” as the absolute truth about conception. It was a common and widely accepted belief that the unborn were not fully alive, or at least not fully human, until several months after conception, when those first movements were felt.

  Therefore, the quickening was not just the unborn child becoming animated but the moment the unborn child received its rational soul.

  Even doctors from this era—who were still early into their studies of embryology—gave credence to this idea, explaining that the womb “seemed capable of producing growths that mimicked fetuses so persuasively that only the absence of fetal movement gave them away as mere ‘moles’ or ‘false conceptions.’”

  Or as one nineteenth-century physician bluntly put it, “Not everything which comes from the birth parts of a woman is a human being.”

  So while it was generally understood that pregnancy was a nine- to ten-month process, the quickening became the main determining factor for pregnancy as well as the beginning of human life and, perhaps more importantly, the mother’s moral responsibility to that life.

  In part because of the moral loophole that the concept of the quickening provided, abortion that took place before the quickening wouldn’t technically be a crime in America for another seventy years. An estimated one in every thirty pregnancies was terminated in the nineteenth century.

  Poor women did it by drinking mild poisons, or thrusting certain plants or crude tools into their bodies. Some would endure being struck repeatedly in the abdomen until the desired effect was achieved.

  For those with more money, abortifacient drugs and surgical abortions were becoming commercially available in America, particularly along the Eastern Seaboard, where advertisements for abortion services ran in the local papers.

  Abortions were so popular and common that one woman in New York City—born with the name Ann Trow Lohman but publicly known as Madame Restell—made a fortune by boldly and shamelessly offering abortions commercially in the late 1830s. Her New York City–based abortion business, which included pills and surgery, grew so popular that she opened additional storefronts in Boston and Philadelphia.

  But the tide was changing in America. Physicians were moving toward the view that human life began at conception rather than at the quickening, and medical testimony in nineteenth-century criminal cases had a growing influence on both law and popular opinion. One of the earliest cases to challenge and ultimately change abortion law in America called to the stand as its medical expert one Dr. Charles D. Meigs.

  • • •

  By the time Meigs examined Eliza Sowers, she had already been dead for some time. Evidence of her final pain-racked days could be found all over her small, pale corpse, “mute testimony to medicine gone wrong,” as Meigs’s friend Dr. James Rush had warned.

  Eliza—a former paper mill worker who had recently seen her station in life improve when she was hired to be a maid and was asked for her hand in marriage—had tried everything to end her terribly timed pregnancy. She swallowed magnesia, and tansy, and pennyroyal. She
was bled. She consumed cups of tea made from powdered roots. She drank down one and a half bottles of an unknown wine-colored “medicine” she got from a local doctor with the promise that it would “make her regular,” gagging on the liquid, which she said was “sharp to the taste.” When it didn’t work, she desperately did the whole routine again a few weeks later. At night, she begged her sister, with whom she shared a bed, to help her, but no matter what they did, she couldn’t, as they said at the time, “get to rights.”

  When Eliza finally began to show, her new boss referred her to Henry Chauncey, a self-described “botanical physician” who assured the young woman and her boss that this situation could easily be remedied.

  Chauncey secured Eliza a room in a boardinghouse far from her home and place of employment. Its main selling point was that it was known for not asking questions. Chauncey then gave Eliza a new round of tinctures and formulas to drink—a black-powder tea, ergot, savin oil—and left, assuring her that nature would take its course.

  Unfortunately for Eliza, nothing changed except her level of suffering, which grew and grew until the woman in charge of the boardinghouse hunted down the “doctor” to fix the situation. Witnesses later would testify that when Chauncey reentered Eliza’s room, he carried something that “shined and looked like a knitting needle” to finish what he believed his “medicine” had started. Eliza’s piercing screams rattled the closed boardinghouse door, and almost immediately after, Chauncey left the boardinghouse again.

  Eliza bled alone and heavily into the night and through the next day. And the next. And the next. Finally, after a week, a nervous Chauncey moved the girl’s pale, tortured body to a different boardinghouse—this one frequented by prostitutes. Regrettably for Chauncey, the landlady at this boardinghouse knew exactly what was happening, and the severity of the situation. After a night of watching Eliza moan in pain, and constantly replacing the hot bricks at her feet to keep her warm, the landlady called in Dr. James Rush, a well-known and respected doctor in Philadelphia. He would later testify that he knew at first glance she was going to die.

  “I found her with a livid face [and] wild staring eye,” he told the court at Chauncey’s trial, “sighing, moaning and excla[iming] of agony; her abdomen was very much swollen, and hard and tender to the touch; her extremities cold and she was pulseless.”

  Rush shared his ultimate conclusion with Chauncey: There was no saving her. Chauncey agreed, and together, they fed her six or seven glasses of wine, which would serve as the only treatment she received while Rush was there. Rush convinced Chauncey to move her to his house so she wouldn’t have to die in such disreputable lodgings, and he did. But the next day, either in transit or soon after arriving at Chauncey’s house, Eliza Sowers died. She was twenty-one years of age.

  And now, Dr. Charles D. Meigs was staring at her lifeless body, having been asked to testify at the trial of her murder. This wasn’t the first time Meigs had been called to such a harrowing scene, but it had been a while.

  After his wife demanded that they return to Philadelphia (being unable to stomach the relentless presence of slavery in her husband’s native South), Meigs found his first patients among the poor and destitute. While the position of his wife’s family in society provided him with an introduction to several esteemed circles, his relatives and their friends did not, and indeed they could not be expected to employ him in so delicate a position as that of their family obstetrician until he had proven himself fit to be trusted and sufficiently skilled. Meigs had no choice but to start at the bottom. But through hard work and persistence, he was able to secure patients of higher and increasingly more impressive social rank.

  Meigs didn’t have an easy time at first. Early in his career, he had several very difficult cases of childbirth, which “greatly disturbed and tried his strength and nerves.” In one of the cases, he made a wrong diagnosis and though the mother and child survived, relatively unharmed, the mistake haunted him. He eventually became “so disgusted” with himself for the error that he quit practicing obstetrics to relieve himself of “the painful responsibility which belongs to that branch.”

  For two straight years, he worked purely as a general physician and sent all such obstetric and gynecological cases to his friends. But he found it impossible to maintain a practice without obstetrics. With his family growing and his expenses increasing, he admitted that he “began to fancy that the wolf was approaching his door.” For the sake of his family and his finances, Meigs returned to obstetrics but this time with a new steely boldness, perhaps born from his discomfort at being forced to practice it at all.

  From that day forward, Meigs’s vision for women’s health was clear and plainly stated: A physician for women must be “endowed with a clear perceptive power; a sound judgment; a proper degree of intelligence; and a familiarity with the doctrines of a good medical school.” And once a physician had obtained this high level of competency, he must be somewhat ruthless in his firmness about what should be done. Once Meigs embraced this philosophy, his business and reputation only increased.

  • • •

  When Meigs was asked to testify in the Eliza Sowers trial, it was an important moment in his career. The trial had already attracted much attention. It had a tragic figure at its center: Eliza, the type of working-class girl trying to live a better life, with whom many in Philadelphia could identify. And it had its villain, Chauncey, who at first denied that Eliza was even pregnant when he began treating her. He told Rush that it was a simple case of inflammation brought on by excess food and drink as well as exposure to a damp draft in Sowers’s room.

  And to make matters worse, he attempted to paint Eliza’s last hours alive not as a time of unimaginable suffering, but rather a “period of religious ecstasy.” He claimed that in her last moments, she was whispering prayers with a placid smile, utterly joyful at the “blissful immortality in the world to come.”

  It was only after a friend of Eliza’s demanded her body be disinterred, and three separate physicians confirmed she was pregnant—using as evidence the fact that her uterus was twice the size of a non-pregnant woman’s, and the fact that when they sliced into her ashen left breast, “the milk flowed freely”—that Chauncey finally admitted she had been pregnant. He explained that he had lied only “to spare the feeling of the family.” The physician estimated that she was at least five months pregnant when she died, and the cause of death was an infection “resulting from a laceration of the uterus caused by an instrumental abortion.”

  • • •

  When Chauncey was arrested and indicted for the murder of Eliza Sowers, the American medical world took notice, and not just because of the drama of the distressing tale. Rather, they were deeply invested in the outcome of the case because they knew it would affect their practices.

  Chauncey had four distinct charges lodged against him. The first two charges—murder by simple assault, and murder by means of poison—were less important to the medical community than the last two: murder by means of assault and abortion, and murder by means of mere abortion.

  The Eliza Sowers case proved to be a turning point in how America viewed abortion—or at least how the American legal system would begin to view it. When Chauncey was initially being charged and held for murder, he attempted to get bail through a loophole regarding how the law defined murder. He demanded that he be released on bail on the grounds “that it was a defendant’s right in murder cases where ‘intent to take life’ was not present. But with intent absent, how could this be considered a murder case at all?”

  The release was refused. It was plainly explained: “The death of the mother following criminal abortion is murder, not because the agent accomplishing the act intended to kill the female, but because, the act being unlawful in itself, he is held responsible for all its results.”

  With this statement and its resulting act, abortion was being formally criminalized. But an important di
stinction was made. The court described the criminality of abortions as being “necessarily attended with great danger to the persons on whom they are practiced,” implying that the ground of its unlawfulness was its tendency to injure the woman (which was often cited as the reason abortions could be considered unlawful). Now new language was also added, and the court formally termed abortion the “destruction of [the] offspring” and an act “feloniously to destroy the fruit of [the woman’s] womb.”

  Therefore, for the first time, abortion was legally viewed as something that could bring harm to the mother as well as the death of the unborn.

  When bail was denied and details of the case were released, the trial became a citywide obsession. After an intense jury selection process, more than seventy witnesses (most of them for the defense) testified for nearly a week before a crowded courtroom.

  The prosecution likely hoped that the esteemed Dr. Meigs would help shine a light into the dark areas of reproductive science. But instead, Meigs unwittingly showed just how little nineteenth-century doctors could admit to knowing about the reproductive process in women.

  When Meigs took the stand as one of the three physicians who examined Eliza Sowers’s body, he openly admitted that he did not clearly understand how conception took place. He did say that he understood it enough to reject the whole idea of the quickening as worthless, and declared that making it a demarcation point for whether or not a woman could legally get an abortion was “very great nonsense on the part of the lawyers.”

  Furthermore, knowing that the media’s spotlight was upon him, Meigs took the opportunity to chastise any woman—including the late Eliza Sowers—who approached physicians requesting an abortion. After all, “did they not know their own duty as well as their physicians?”