"Her Daily Concern:" Women's Health Issues in Early 19th-Century Indiana
Author: Timothy Crumrin, Conner Prairie Historian Publication forthcoming. Not to be reproduced without permission
Scourges of the Land
Illness-- which might strike, suddenly, openly, like a summer storm, or slowly, furtively, like a night thief-- was an incontrovertible fact of early midwestern life. This, of course, greatly effected pioneer women, who were, after all, prey not only to illnesses which touched everyone, but also to those peculiar to their gender. Indeed, it can be said, that in the matter of health, women often had the worst of both worlds. That pioneer women were much concerned about this is strikingly evident from their letters and diaries. Nearly all made mention of their health or that of loved ones. Often, letters, like those of Mary Hovey, an 1830s immigrant to Indiana, were catalogues of symptoms, illness, and complaints.
However, by modern standards, there was precious little the women of this period could do about their concerns; they were all but powerless in their struggle against disease. Living in the time before the formulation of the germ theory of disease, women and men were unaware of the important connection between the lack of proper sanitation and illness. Early midwesterners lived side by side with their own waste and that of their neighbors. They drank polluted water and ate poorly prepared, tainted food. Their diets were poor and given over heavily to starchy foods. In addition they were grossly outnumbered by the disease bearing insects which swarmed around them, bringing with them malarial fevers and other illnesses. When the above is added to a general lack of cleanliness and various environmental hazards, it is not difficult to understand why pioneers kept such a weather eye out for symptoms.
The treatment of disease could be equally crude. Early midwesterners sometimes resorted to charms, potions, and home remedies to take up the battle against ill health. A bag of live insects hung around the victims neck was thought to cure whooping cough, while "punkin seed tea" was prescribed for convulsions.
The "medical profession" often offered cures that were only slightly more effective. Physicians were often inadequately trained, with little formal education. Some had learned on the job as apprentices to established doctors and rarely climbed inside a medical text. As a consequence their treatments were often only a step or two above folk remedies. The not so-gentle-ministrations of the period have been summed up as "bleed, blister, and purge." Physicians regularly practiced bloodletting, purging with emetics, and other invasive techniques. The sometimes destructive use of such orthodox, or "heroic" medicine, promoted the growth of quackery, with its various potions, and alternative health care providers like Thomsonians, who relied on herbal remedies. All in all, the antebellum period was not a propitious time for good health.
Disease lived in the picturesque midwestern landscapes. Fevers of various types were possibly the most prevalent kinds of illness. Bilious, or continued fevers, were the most common in newly settled areas. Close behind were malarial- type intermittent fevers like ague (usually pronounced "ager" in the midwest). Incidence of both diseases usually declined with the clearing of land and draining of swampy lands, which lowered the number of disease-bearing insects. Such fevers were normally seasonal, like Ague which usually appeared between June and October and could be quite deadly. In 1821, one-eighth of the population of Indianapolis died of both intermittent and unremitting fevers. Other seasonal illnesses such as whooping cough, pleurisy, and consumption also collected a grave toll from both sexes.
But disease could strike at any time. Most dreaded were the epidemics of cholera and small pox. Such diseases were like menacing, foreign invaders approaching from a distance; the warning only added to the fears. Alarms were sounded; any preparations which could be effected were made. Areas buzzed with foreboding and rumor as the assailant moved ever nearer. Cholera outbreaks flashed through the midwest in the 1830s, killing 22 in Madison, Indiana in November, 1832 and returning for an even more virulent visit to the Aurora/Salem area of the state in 1838, when cholera morbos took away 100 of 800 residents. Typhoid and smallpox epidemics wrought their havoc also (even though a smallpox vaccine was available in Indiana by 1817) and cancer, heart disease, and other illnesses took large tolls. Women, then, had all these things to consider, plus others.
Pioneer women were subjected to diseases and ailments that were not only exclusive to them, but also exacerbated by their "place" in life. As one historian put it:
"Women were cast in a limited role in the 1800s. Child rearing was a primary responsibility, and women spent much of their married lives either pregnant or caring for children. Safe and effective contraceptives were not popularized until late in the century. Her role as mother contributed substantially to her poor health, and her modesty prevented her from receiving proper medical attention."
The quintessential role for women in the early nineteenth century was that of mother; a woman was to bear and raise children. How often and how well. she did that was often the only determining factor in how she was measured and defined. The number of children she bore was largely determined by the age at which she married and her remaining fertile years. Exact numbers on family size are impossible to ascertain due to many circumstances, but some general figures tell a compelling story. First generation pioneer women in 1820s Illinois had children approximately every 26-30 months. Over sixty percent had six to nine children, thirty percent had ten or more, and only ten percent gave birth to less than six children in their lifetime. According to 1840 census figures, women in Hamilton County, Indiana had an average of eight children during their lifetime.
Such high birth rates (which probably do not reflect miscarriages or stillbirths) undoubtedly had an adverse effect on a woman's health. In fact, a women's life expectancy during her childbearing years of twenty to forty-five was lower than that of men the comparable age, and only rose to that of men with a woman's passage beyond childbearing.
Childbirth, or parturition, was an event especially fraught with peril in antebellum America. Any abnormality might end in disaster. A fetus in the breech or other abnormal position could lead to the death of both mother and child. At times, "difficult or protracted labor" resulted in what today seem barbaric or ghoulish methods of treatment as physicians sometimes had to perform embryotomies to save the mother. An embryotomy was the act of separation of any part of the fetus while in utero. This might involve decapitation or extraction of a limb to permit extraction of the fetus. The physical and emotional toll of such procedures were enormous for the mother (and doctor), but few other options were open to the physician. Caesareans were "rarely performed during the first half of the nineteenth century" so one avenue to alleviate suffering and ensure a safe birth was generally closed. In cases when the rare procedure was performed, fatalities often ensued due to infections.
There was an advancement open to pioneer women which helped alleviate some of childbirth's inherent dangers. The 1740 introduction of the curved forceps and its increasing adoption by doctors lessened the need for embryotomies and greatly facilitated birthing. Forceps also brought more men through the expectant mother' doorway. The birthing area, once an almost exclusively female province of midwives, or "grannies," became host to increasing numbers of males.
Special training was required to use curved forceps properly, and it was normally only available to men. This training increased the number of physicians with advanced education in obstetrics and led to the rise of male midwives, sometimes also known as accoucheurs, whose specialty was use of the forceps. The advancement was a boon to the expectant mother. Curved forceps (despite the risks involved if ill-used) certainly reduced suffering and offered "safer and shorter" parturition (the process of giving birth). According to some experts, it also placed accouchement and parturition "almost exclusively in the hands" of males-- at least in the east. It is also held by some that untrained midwives had all but been replaced by doctors or male accoucheur in northern urban areas. The same was not so true in the midwest, where midwives were still much employed and medical techniques were sometimes slow in catching on.
Doctors and male midwives played an increasing role in Indiana and the midwest during this period, but female midwives were still heavily employed, most frequently in rural or newly settled areas. The reasons were many. Doctors and other specialists were still sparsely represented in many parts of the midwest; many felt more comfortable with the old ways and did not trust "medicine." And many women felt highly uncomfortable with a male's intrusion into such a "private" matter. Thus the midwife was called to many bed sides. A Jay County, Indiana, woman claimed to have delivered over 900 babies from 1840 to 1897. In central Illinois "'grannies'" (midwives) helped more than 'regulars' (doctors) in the most recurrent medical emergency in the country side, the delivery bed." Thomsonian medicine adherents believed parturition should be handled by female midwives who would maintain the mother on herbal potions and keep her "in a state of perspiration" through delivery.
The primary drawback to the use of female midwives was their lack of formal training, which might leave them unable to help a patient enduring a complicated birth. Among their advantages were experience, proximity and availability, and gender. Many women during the period felt much more comfortable with their own sex attending them. For these women, the doctor was called in only when difficulties arose; sometimes he arrived too late.
Birth control was not an openly discussed or viable option for most women of the early nineteenth century. Some women, however, were well aware of the dangers to their health by pregnancy and childbirth and the health difficulties in constantly having to care for a large brood of children. Others simply wished to limit the number of their children for personal reasons. The options open to these groups were limited. Birth control on a systematic basis hardly existed during the period. Contraceptive information was difficult to obtain and most of it, by modern standards, was specious. Additionally, societal norms and pressures encouraged the sacred state of motherhood and dissuaded any attempts at family planning. Still, some women did indeed seek ways of reducing their risks of pregnancy-- usually only with sporadic success.
Some turned to their doctors, but members of the medical fraternity were not always helpful. Many physicians were uncomfortable with dealing with such matters, while others were merely repositories of misinformation. Doctors often could not even help with the most readily available birth control "method." abstinence. A few "so misunderstood" a woman's bodily cycles that they erroneously advised women to abstain from sexual activity during the safe period of the last half of the menstrual cycle and encouraged it "immediately after ovulation," which put the woman at great risk of pregnancy. Abstinence and other "natural" means, such as coitus interruptus and that "long traditional" preindustrial contraceptive method, prolongation of nursing, were the most oft-used methods during the time, but were seldom considered a topic suitable for a proper lady's diary, letter, or conversation.
However, other means were employed. Feminine networking allowed for the dissemination of contraceptive information. On the midwestern frontier, women passed on such unlikely-- and ineffective-- folk remedies as drinking a concoction featuring gunpowder or eating dried chicken gizzards. Although some "mechanical" devices, such as condoms or sponges were known, they were not readily accessible to the pioneer woman and were likely used only by a minuscule number of Americans-- especially prior to the 1830s. Some loosening of the control of contraceptive information occurred in the 1830s. More extensive information became available with the publication of Robert Dale Owens Moral Physiology (1831) and Knowlton's The Fruits of Philosophy (1832), which contained frank discussions of contraception and reached a wide audience despite, or because, of the scandal and legal proceedings attached to their publication.
When contraception failed, as it was often wont to do, there was abortion. Abortion in the early nineteenth century simply did not elicit the controversy or comment as today (though it was rarely discussed as openly). Though not openly encouraged, it was not necessarily condemned out of hand if carried out early in the pregnancy. Many believed it permissible if done before "quickening," or movement by the fetus, which usually occurred in the second trimester. The first anti-abortion law was enacted in Connecticut in 1821, but it was basically an anti-poisoning law that stipulated it a crime if the woman was "quick with child." In essence, the law was aimed at doctors or potion-sellers whose medicines might cause an unwanted abortion. Quickening was the decisive issue every time abortion was raised in court prior to 1840. if the abortion took place before quickening it was not adjudged a crime. Indiana made abortions illegal in 1835, and did make the distinction regarding quickening. The Hoosier law was a rarity. Most "laws enacted between 1820 and 1840 retained the quickening doctrine and attempted to protect women from unwanted abortion, rather than prosecute them."
Abortion, however, was not considered a significant "means of family limitation" during the first third of the century. It was mainly viewed as a way of avoiding the scandal attached to an illicit affair or birth out of wedlock. However, by the late 1830s a change in the type of person seeking abortions and, and the reasons behind it, became evident. The rising abortion rate of the period probably reflected a desire on the part of married women to limit family size. It is estimated that the abortion rate jumped from one abortion in every 25-35 live births during 1800-1830 to one in every 5-6 live births by 1850. These figures may be a bit high (evidence is still sketchy), but are indicative of a trend.
As the above indicates, abortion, like birth control information, became more available between 1830 and 1850. That period saw a mail order and retail abortifacient drug trade flourish. A woman could send away for certain pills or discreetly purchase them at a store. Surgical methods were "available, but dangerous." This openness and commercial availability was mainly a feature of northern urban areas. Like much other technological and cultural change, it was later in its arrival in the midwest, and the average midwestern woman likely had a more difficult time in obtaining an abortion than her eastern, urban counterpart if she desired one.
It was not, however, impossible. Such information and abortifacients were within reach of a woman if she grasped hard enough. Herbal abortifacients were the most widely utilized in rural, nineteenth century America. Again, networking and word-of-mouth broadcast specious methods. Women who relied on such information sometimes resorted to rubbing gunpowder on their breasts or drinking a "tea" brewed with rusty nail water. Other suggestions included "bleeding from the foot, hot baths, and cathartics." Midwives were thought reliable informants and were wont to prescribe seneca, snakeroot, or cohosh, the favored method of Native American women. Thomsonians claimed the preferred "remedy" was a mixture of tansy syrup and rum.
More reliable sources of information were the ever popular home medical books. If a woman knew where to look the information was easily gleaned. One book, Samuel Jennings' The Married Ladies Companion, was meant especially to be used by rural women. It offered frank advice for women who "took a common cold," the period colloquialism for missing a period. It urged using cathartics like aloe and calomel, and bleeding to restore menstruation. Abortion information was usually available in two sections of home medical books: how to "release obstructed menses" and "dangers" to avoid during pregnancy.
The latter section was a sort of how-to in reverse that could be effectively put to use by the reader. The most widely consulted work, Buchan's Domestic Medicine, advised emetics and a mixture of prepared steel, powdered myrrh, and aloe to "restore menstrual flow." Under causes of abortion to be avoided, it listed violent exercise, jumping too high, blows to the belly, and lifting great weights. Clearly, any woman wishing badly enough to abort could find a solution to her dilemma, without relying on outside aid. If she wished to rely on herbal remedies, they could be easily obtained. Aloes, one of the most widely urged and effective abortifacient, were regularly advertised in newspapers as being available in local stores.
Of course, the number of women who availed themselves of the abortion option cannot be properly approximated. It is enough to say that abortion was feasible, available, and used option; it was a likely contributor to the birth rate falling by mid-century.
Public discussion of a woman's body and its health was frowned upon during the first half of the nineteenth century. Some have called it a taboo topic. Not only was it seldom mentioned publicly, women and their own doctors were uncomfortable discussing "female matters." Vaginal and pelvic exams were rare and cursory at best. Such prudishness undoubtedly contributed to a more rapid progression of disease and a quicker deterioration of an afflicted woman's condition. gynecological problems often went unmentioned and untreated. Simple operations on breast tumors took place, but treatment was rudimentary and met with little success. For the most part, then, treatment of "female matters'" suffered due to the same lack of knowledge and technique as other diseases.
In essence, the pioneer woman's body was much less her than that of her modern counterpart. Indeed, it was much less her own than her contemporaries living in northern urban areas. The midwestern woman of 1800-1850 was likely exposed to disease, more unhealthy conditions, more of life's hazards, than most of her gender. As with other aspects of her life, her existence was a problematic one. Yet, hampered by ignorance, exposed to a myriad number of diseases, she survived, even flourished.