Testing the Reproductive Hypothesis: or what made working-class women sick in early Victorian London

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Testing the reproductive hypothesis: or what madeworking-class women sick in early Victorian LondonMarjorie Levine-Clark aa University of Colorado at Denver , USAPublished online: 20 Dec 2006.

To cite this article: Marjorie Levine-Clark (2002) Testing the reproductive hypothesis: or what made working-class womensick in early Victorian London, Women's History Review, 11:2, 175-200, DOI: 10.1080/09612020200200317

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Women’s History Review, Volume 11, Number 2, 2002

175

Testing the Reproductive Hypothesis: or what made working-class women sick in early Victorian London

MARJORIE LEVINE-CLARK University of Colorado at Denver, USA

ABSTRACT Using patient case records from University College Hospital in London in the 1830s and 1840s, this article re-evaluates the reproductive model of Victorian women’s health. The women who were admitted to UCH were working-class women, and the evidence from the patient records suggests that their understandings of their bodies both conflicted with and supported the Victorian medical model of women as biologically fragile and delicate as a result of their reproductive functions. The female patients represented their bodies as essentially strong, but also recognized that this strength was very tenuous. Rather than concentrating solely on internally induced causes of ill health, the patients stressed socio-economic reasons for becoming sick.

Using the question ‘what makes women sick,’ Lesley Doyal recently analyzed the politics of women’s health in the late twentieth century from a global perspective. In her study, she stressed the significance of economic, social, and cultural influences on physical and mental well-being, and explored the different facets of women’s lives that have an impact upon their health.[1] Historically, ‘women’s diseases,’ or women’s health problems, have been identified with women’s physiological differences from men – those associated with their reproductive organs. Asking ‘what makes women sick’ in historical perspective has usually generated a response that stresses female reproductivity. This is certainly the case for Victorian England; both Victorian doctors and the historians who have written about them have emphasized theories that linked women’s illnesses to their reproductive functions. Yet, as this study will show, in the early Victorian years, many women were more prone to blame their ill health on socio-economic factors, like those identified by Doyal.

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For the Victorian period, most of the information we have concerning English women’s health comes from prescriptive medical literature describing the functions of the female body.[2] Historians have used this material to analyze the medical construction of womanhood. Many have addressed the interplay of medical description and social norms of femininity, emphasizing how social and medical prescriptions reinforced each other. These prescriptions stressed women’s inherent weakness and natural suitability for the private domestic sphere and unsuitability for work outside the home. The patients under consideration have been for the most part middle-class women, examined in the privacy of their homes or doctors’ offices. Diaries, letters, and fiction written by women of the upper and middle ranks of society have also been used to help understand how women thought about their health, and especially about their reproductive health.[3] Each of these approaches to Victorian women’s health, however, has focused on reproduction as the central aspect defining women’s experiences of health and illness.

The emphasis on the politics of women’s reproduction in feminist histories has led to a neglect of women’s other health issues. Scholarly studies have tended to follow the Victorian medical literature in demonstrating that medical practitioners understood the diseases of women in terms of reproductive processes and recommended a social role that suited the supposed delicacy of the female reproductive apparatus. In this way, historians have tended to reproduce the point of view of the doctors, rather than the points of view of the patients. Likewise, the historical focus on the health experiences – reproductive or otherwise – of middle-class women has led to generalizations about the experiences of all women. Although most historians recognize that the medical and social ideal of delicate femininity neglected working-class experiences, little has been done to flesh out the picture of health and illness in working women’s lives.

This study examines early Victorian women’s health through an analysis of an under-utilized source of information: patient case histories from hospitals.[4] For the 1830s and 1840s, twenty-six volumes of patient case records survive intact from the female wards of University College Hospital (UCH) in London.[5] I have examined twenty of these volumes, which cover the years 1835 to 1847. This sample contains the cases of 2439 in-patient admissions [6], under the care of one surgeon – Robert Liston – and five physicians – Anthony Todd Thomson, C.J.B. Williams, John Taylor, John Elliotson, and Robert Carswell.[7] The patients of these doctors were working women, and the illnesses with which they came to the hospital often had little to do with their reproductive health. The hospital records provide an exciting source of information on the lives of laboring women and encourage historians to address new issues surrounding female health.

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Though unsystematic, the patient histories from UCH offer rich documentation on patients’ biographical particulars and perceptions of their health, as well as technical medical information concerning diagnosis and treatment. In this article, I identify the women who visited UCH in the early Victorian period and explore how they represented their illnesses to their medical practitioners. While Victorian medical texts concluded that the female reproductive functions played the decisive role in determining female health and illness, and that female biology rendered female health unstable, the patient histories indicate that women’s understandings of the functioning of their bodies were much more conflicted regarding the connections between female biology and the causation of illness. These women of the laboring classes stressed that their illnesses were produced by social, cultural, and environmental, as well as biological, factors that interacted with their own particular understandings of the body. The evidence from the UCH patient records suggests that working women’s perceptions of their bodies were both in tension with and in support of an image of women as biologically fragile and delicate. Because their survival depended upon their ability to work – both for wages and unpaid in their homes – poor women represented their physical potentiality as strong and hardy, but recognized the obstacles to achieving or maintaining that potential.

Until recently, few medical historians approached their subjects from the point of view of the patient. Medical history has focused on the achievements of individual practitioners, progress in disease prevention and cure, and the development of professionalism and medical institutions. This has had important implications for our understandings of early Victorian women’s health, for by focusing on official accounts, historians have limited their analyses to male voices. In the last decade or two, however, there have been numerous studies on the relationships between patients and their practitioners, and patients’ perspectives on their health care choices. For the most part, even these studies have focused on well-to-do patients, with Mary Fissell’s work on eighteenth-century Bristol being a notable exception.[8] Additionally, men’s health narratives have been more prevalent than women’s. Case histories as historical documents have been examined predominantly for what they can tell us about advances in medical therapeutics and the development of medical record-keeping, but more and more historians are exploring the uses of case histories to uncover patient perspectives about their health and health care choices, and to examine relationships between doctor and patient.[9] Analyzing the published cases of one doctor in early eighteenth-century Germany to explore patients’ understandings of their bodies, Barbara Duden’s work has shown the richness available in this type of source, particularly in looking at patients’ descriptions of illnesses.[10]

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There is, however, debate as to whether the patient’s narrative matters at all by the period at which I am looking. N.D. Jewson, in a classic sociological article, argues for the ‘Disappearance of the Sick-Man from Medical Cosmology,’ beginning at the turn of the nineteenth century. What the patient had to say about his (or her) disease experiences became less important as medical practitioners limited their gaze to ‘internal organic events,’ as opposed to the ‘total symptom complex’ of the patient.[11] Medical men relied less and less on the patient’s experiences of illness in a wider context. Similarly, the medical historian Mary Fissell claims that the ‘patient’s narrative of illness was made utterly redundant’ by the early Victorian period.[12] Increasing medical autonomy in the eighteenth century altered the interaction between patient and doctor, from one in which they shared common concepts and a negotiated system of diagnosis and treatment, to one in which the patient’s part was significantly diminished. As professional practitioners relied on more localized, organic understandings of the body and less on systemic, humoral understandings, a patient’s description of her illness was not as important as her doctor’s conceptualization of disease. Examining the cases of working-class women, however, challenges the notion that the patient’s perceptions and words were less important in the early Victorian period, and, indeed, that humoral medicine was obsolete. The doctors at UCH used detailed case histories and responded to what their patients had to say. In focusing on the patients’ telling of their medical and social histories, I attempt to give voice to their experiences of illness and particularly to what they thought made them sick.

This focus on the patient’s perspective is particularly significant with reference to female patients, whom scholars have often represented as passive victims of medical authority.[13] Historians have looked at how medical men defined women and their capabilities through an understanding of the ‘diseases of women.’ In these studies, women appear as patients – for the most part passive – who are understood by the expert medical gaze.[14] Nancy Theriot, in a study of women’s nervousness and insanity in nineteenth-century America, has gone some way to challenge this representation, arguing that women as patients were involved in the process of diagnosis, and indeed ‘were active participants in the process of medicalizing woman.’[15] Nonetheless, most historians’ concerns with the ways in which physicians have approached female bodies have been directed toward middle-class women or prostitutes.[16] This study engages these issues, exploring how London working-class women – as patients – were actively involved in defining their bodies and representing their illness experiences to their medical practitioners.

Although there are some minor differences in the format of the case histories throughout the period of my study, I analyze the cases as a group. The case histories were written by physicians’ clerks and surgeons’ dressers,

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who were pupils at the hospital. These clerks and dressers – all men – were appointed by the Hospital Medical Committee, based on recommendations and performance as students, and served in their positions for three-month periods.[17] It appears that one of the chief responsibilities of these students was the construction of the patient’s case record, which meant the initial transcription of the patient’s narrative of social and medical history and present illness, and the subsequent following through of the case treatment and progress.[18]

The cases are roughly divided into three sections. The ‘history’ section of the case record contains the patient’s social and medical history. The vast majority of cases contain biographical information which includes name, age, marital status and relationships, number of children, occupation and condition of place of work, place and condition of residence, place of birth, and financial state. The medical history includes patient descriptions of their previous illnesses, present illness, parents’ and siblings’ health histories with notes about hereditary disposition, and the causes to which patients attributed their illnesses. All this biographical and medical information, however, was recorded unsystematically, from volume to volume, or even case to case. Some cases allow for extremely fruitful readings, while others prove rather barren. I additionally rely on the ‘present symptoms’ section, which describes the patient’s current experiences of illness. I give less attention to the ‘treatment’ section, which encompasses the doctor’s examination and diagnosis, the course of treatment, and the patient’s progress.[19] The patient is present in each of these sections, as her medical practitioner listens to what she says and notes her responses, but her voice is clearest in the notes on her history. In establishing the social and medical history, the representation of illness was produced through an interaction between the clerk and the patient; while the information was solicited from the clerk through a formula, the patient’s responses are often indicated as if in her own voice, or the language of the response can be inferred to be the voice of the patient. In cases where the patient was too ill to give her own history, relatives or friends contributed these details.

The nature of my project makes certain assumptions about the case history as a source of knowledge. While I do not claim that we can get at working women’s ‘experience’ through an analysis of the patient narratives, I do argue that these documents can reveal how patients talked about their bodies and represented their lives to their medical practitioners.[20] They made choices about what to say, just as the clerks and doctors made choices about what to include in the records. As with any historical document, the case history needs to be scrutinized as a representation of a certain reality. Any analysis has to recognize that what seem to be first-hand patient descriptions are mediated by the clerk and/or physician. As Guenter Risse & John Harley Warner point out, the historian has to tread carefully when

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using patient records, as there is ‘no doubt the history-taker frequently reinterpreted, misunderstood, or dismissed what the patient said.’[21] What the clerk or physician understood the patient to be saying could have been very different from what the patient understood herself to be saying.

Taking into account the representational nature of the knowledge about working women contained in them, the case histories provide rich insight into various layers of the patients’ perceptions of health and illness. This is particularly important for exploring female health, as the majority of texts from the early Victorian period were written by men. While case records cannot tell us what women experienced, they can suggest how women expressed their experiences to their doctors and what was important to them in their understandings of their bodies. The structure of information in each case grows out of the patient’s life, and all the material within the case is considered relevant to the bodily changes that brought her to the Hospital.

University College Hospital opened on Gower Street in 1834 as the North London Hospital. A medical charity, the hospital was funded by subscriptions from donors who contributed money to care for the sick poor of Islington and St Pancras.[22] Suitable cases were defined by the hospital governors as those patients who could obtain the requisite ticket of recommendation from a subscriber to the hospital. Subscribers included known pillars of the community, charitable individuals, employers of working people, clergy, and various working-class self-help men’s clubs, among others.[23] In 1837, the hospital’s name was changed to University College Hospital to reflect the connections between the University of London and the Hospital.[24] UCH originally contained 130 beds, but by 1846, it was large enough to house 200 beds, with separate wards for medical and surgical patients, as well as a ward specific to obstetrical cases.[25] The Hospital’s physicians and surgeons, typical of London hospital practitioners, saw a large number of patients in the early Victorian years. For example, from November 1, 1836 to November 1, 1837, 1270 inpatients, and 3000 outpatients were admitted, as well as 10,850 casualties relieved without a recommendation from a subscriber. While the number of inpatients fluctuated between 1200 and 1500 a year in the 1830s and 1840s, the Hospital’s medical attendants saw up to 7500 outpatients and over 14,000 casualties annually.[26]

The patients who came to UCH were working people; ideally, they were of the ‘respectable’ working poor, those who would be considered worthy of charitable relief. Most of the women who came to the Hospital were gainfully employed, but throughout the Victorian era, women’s occupations in London were unstable and poorly paid, and often placed women in states of economic and physical dependency. Some 61% (1490) of the cases in the UCH sample noted occupation. Of these, 921 women identified their

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occupation as some sort of domestic service, be it cook, housemaid, general servant, or maid of all work.[27] The second largest occupational group was laundresses and washerwomen, encompassing 110 of the patients, and the third largest the eighty-seven women occupied in needlework or the needle trades (especially dressmaking and millinery). These three categories of labor – service, laundry and needlework – made up 75% of all the women admitted to the hospital with occupation given. Other employments which recur in the sample are charwomen, fruit sellers, nurses, and milk women. There are a few shopkeepers, as well as a few women who worked with their husbands in trade – as tailors or shoebinders, for example. Thirty-one women claimed that they were solely occupied at home with domestic duties, while twenty-one indicated that they had no occupation. Nineteen women were identified as prostitutes or ‘on the town,’ making up about 1.3% of those noting occupation. Only one woman was clearly employed in some kind of factory work. This occupational sample reflects many of the typical employments in which London women were engaged, although it would have been different for areas such as Spitalfields – a concentrated area of weaving – or other parts of the East End where more women were employed in industries such as match-making.[28]

Ninety-four percent of the UCH case histories recorded age. Over 35% of the women who became inpatients at the hospital were in their twenties (841, 36.5%), and 59% were between the ages of sixteen and thirty-five. In the 1334 cases which noted marital status, 511 women were married, 625 were single, with the remainder being widowed.[29] In all, about 62% of the women patients whose cases noted marital status were unmarried. The patients almost universally lived in London or very close by. Many women, however, indicated that they were not London natives but had come to the metropolis in search of employment, or as part of a move with a family or husband looking for employment. In her study of eighteenth-century Bristol, Mary Fissell has argued that the poor who utilized the Bristol Infirmary were primarily those who fell into dependency without local networks to support them through a health crisis.[30] The large number of unmarried non-London natives suggests that this might also have been the case for the majority of London female hospital patients in the early Victorian years.

Historical explanations of nineteenth-century medicine and female health have stressed an increasing medicalization of women’s bodies, founded upon the reduction of female health to reproductive health.[31] Most medical practitioners agreed that female bodies made women’s health naturally unstable, that women’s ill health was internally induced. In 1845, for example, the physician, Samuel Mason, expounded upon the centrality of the reproductive system to women’s overall health:

It is well known to all in any degree conversant with physiology, what an immense influence the uterus, more especially during the important

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changes which it naturally undergoes, has upon the female system ... Therefore it will be readily conceived, that any derangement of this organ, or defect it in its regular functions, must, to a certain extent, influence the general health, in fact, the growth and healthy development, of the female; and in after-life, too, health or disease frequently bears and an exact ratio to the state of the uterus.[32]

Medical writings connected women’s weakness and propensity for illness to their menstrual periods and the countless things that could go wrong with normal menstruation. As the authors of the Cyclopaedia of Practical Medicine told their readers, ‘there is great liability to derangements, of one form or another, in the menstrual process.’[33] Even though the physician, Edward Tilt, concluded that he found ‘menstruation to have been perfectly regular in eighty-six per cent. of the women’ in his study of 1000, it did not prevent him from dedicating entire books to the subject.[34] Amenorrhea, dysmenorrhea, and menorrhagia – the absence of menstrual discharge, painful menstruation, and excessive menstrual discharge – all featured in writings about the health (or ill health) of women. Medical writings suggest, as Sally Shuttleworth has noted for the mid-Victorian period, that ‘menstruation acted an as external instrument, a barometer by which doctors could read the internal health, mental as well as physical, of their patients.’[35] This vision of the female body has dominated scholarly understandings of Victorian approaches to the health of women and the ways doctors treated their female patients.

The female cases from UCH, however, challenge this monolithic understanding of the relationship between medical theory, medical practice, and women’s health. While there is some evidence that the UCH doctors followed the medical wisdom of the day regarding the dominance of the female reproductive body, the most common diagnosis among the female patients at UCH had nothing to do with the reproductive functions. It was rheumatism. Out of 2199 cases (90%) in which a diagnosis was clearly registered, 223 indicated rheumatism. Hysteria, considered a reproductive disease, as it was defined ‘“essentially to consist in excitement and irritation of the numerous and important nerves supplying the reproductive system,”’[36] was the next largest ailment, with 153 cases. The next five, however, were generally non-reproductive: a group of stomach complaints related to dyspepsia made up over ninety cases, followed by bronchitis with eighty-four; gonorrhea and syphilis (sexual not reproductive diseases) together made up seventy-six cases, anemia counted for seventy cases, and a variety of ulcers and ulcerations made up sixty-eight cases. Menstrual disorders of various sorts accounted for forty diagnosed ailments, while ovarian and uterine diseases made up fifteen cases. There was also one case of ‘climacteric’ disease. In all, ‘reproductive diseases’ made up less than 10% of diagnosed cases.

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This analysis suggests the possibility of a class-based approach to Victorian women’s bodies. Victorian medical theories concerning the centrality of the reproductive body in women’s lives seem to have developed in conjunction with the articulation of a middle-class norm of domesticity and the complementary roles of the sexes.[37] Yet the reality of working-class patients’ lives created tension between the theory of the reproductive body and the practice of working women’s everyday experiences. Irvine Loudon has shown in a study of midwifery care that at least by the late nineteenth century, some doctors had differing ideas about the relationship between the reproductive body, women’s overall health, and the class of the patient. The obstetrician Robert Barnes, for example, ‘offered the explanation that the “physical organs” of working-class women were “in better working order, and are not subjugated and enfeebled by the excessive cultivation of the emotional and intellectual elements.”’[38] An explicit comparison of working-class and middle-class cases would prove extremely interesting.[39]

In recording the patients’ experiences of these various illnesses, the UCH case histories establish that female hospital patients’ understandings of their bodies were conflicted; they saw themselves as naturally healthy, but indicated that their health was very tenuous. Only sometimes did they connect this potential weakness to reproduction. Many patients, in the process of describing what made them ill, emphasized their previous healthiness, strength, and hardiness. Stoutness and ruddiness were signs of healthiness, whereas thinness and pallor were indicative of physical decline. Patients seemed to have been particularly concerned with telling their doctors that they had once possessed the marks of health. One woman who was described by the clerk as of ‘pale complexion’ assured the transcriber that ‘previously ... to the last 12 months, she states her complexion to have been very ruddy.’[40] Sarah R., diagnosed with hysteria and headaches, stressed that ‘she feels very weak and is not near so stout and ruddy as formerly.’[41] A woman suffering from a diseased uterus related that ‘She has not had good health for 2 years, has been getting thin and pale all this time before then she was stout and had a colour.’[42] The patients generally connected health with strength. Eliza P., a dressmaker, told the UCH clerk that she has ‘been generally very healthy and strong.’[43] Similarly, Elizabeth G., a housemaid who came to UCH suffering from paralysis and hysteria, noted that ‘she generally enjoys good health and considers herself strong.’[44] The women’s use of words like ‘robust’ and ‘strong’ to describe themselves previous to their illnesses provides a ready contrast to images of the frail and fainting Victorian lady. Yet, as will be illustrated below, the fragility of their robustness and strength was inherent in the patients’ conceptions of what made them sick.

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In all cases, the patients’ perception of the precariousness of good health is evident. The best indications we have of women’s ideas about their illnesses are the causes they assigned to their various diseases and injuries. While physical accidents and complications from childbirth account for a small number of cases, most of the patients thought they became sick as a result of social and environmental factors common in their everyday lives. The presence or absence of menstruation in combination with these social and environmental factors was significant in patient understandings of their illnesses, but the patient narratives suggest that both doctors and patients regarded ‘normal’ menstruation as a sign of health. There is no indication that women or their doctors believed that menstruation kept women workers from their employments or from going about their daily lives, even though they believed that normal menstrual cycles were important to their overall health. This finding differs from Nancy Theriot’s in her study of female insanity, which concluded that nineteenth-century women ‘most often related their illness to their female bodies.’[45] While it is indeed true that ‘women experienced their reproductive lives as troublesome’ [46], the UCH patients’ understandings of their illnesses both supported and challenged the conventional medical wisdom that women tended naturally to ill health due to their reproductive biology, and principally due to their menstrual cycles.

While the diagnoses indicate that reproductive illnesses may not have been the central ailments sending women to hospitals, the case histories suggest that patients did link problems with their menstrual cycles to their primary illnesses, particularly in terms of causation. For the female hospital patients, irregular menstruation played a central role in understandings of disease as both a sign of illness itself and as a cause of other ailments. Menstruation, however, was never associated with inherent weakness or debility, as it was in much medical literature, and was almost always linked to social and environmental causes. Patients paid close attention to their menstrual cycles, noting in detail the ways in which the environmental conditions under which they lived affected their bodies.[47] Menstruation, in the narratives of the patients, was a visual experience, described by color, quantity, and when the menses made an ‘appearance’ or an ‘attempt.’ Patients indicated that the ‘catamenia have not been seen,’ emphasizing the visual nature of the menstrual cycle. Even when menstruation was not noted as a direct cause of illness, the case histories show that patients and their medical practitioners worried about the state of the women’s menstrual cycles.

The Hospital records reflect a preoccupation by doctors and patients alike with menstrual regularity. The menstrual discharge could be scanty, profuse, pale, and excessive according to the language in the patient histories, and indeed the records are vague as to what constituted a normal

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flow or how this normalcy was established. Whether the clerks supplied the patients with a language to describe menstruation or whether the language was the patients’ own is unclear. It is plain, however, that the patients themselves made judgments as to the normalcy of their menstrual flow. Cases show that women clearly saw changes in their menstrual flow to be indicative of ill health. Elizabeth H., for example, came to see Dr Williams in March of 1840. She related that she ‘enjoyed very good health till 3 years ago when the catamenial discharge became very profuse and caused great debility and loss of flesh.’[48] This patient associated the weakening of her health with the loss of menstrual fluid; the loss of blood was in effect draining her well-being. In some cases, the patients seemed to confirm medical wisdom concerning the dangers of the onset of menstruation at puberty. Ellen D., a twenty year-old housemaid admitted to UCH with amenorrhea in 1840, indicated that the ‘catamenia appeared for the first time about three years ago – at that period her health became deranged.’[49] This woman saw the onset of menstruation as the cause of larger health problems. These cases seem to indicate that ‘deranged’ health was broadly defined to include other bodily systems besides the reproductive.

While these women were indeed concerned with the functioning of their reproductive systems, as evidenced by their attention to menstruation, they attributed their illnesses more often to socio-economic and environmental causes. In the majority of cases where they suggested causes for their health problems, they presented no neat link between their reproductive processes and what made them sick. While menstruation featured regularly in the patients’ narratives, the case histories show that women perceived their ill health arising predominantly from their poverty, their environment, their domestic relationships, and their work – factors which they believed could also have an impact on the normal functioning of their menstrual cycles.

Poverty is an underlying presence in almost all the case histories, indicative of the precariousness of survival for these women. Poor patients associated their declining health with their inability to obtain the ‘necessaries of life.’[50] Lack of adequate shelter or housing were remarked upon by the patients as contributing causes for illness. There were a number of women who, like Elizabeth P., ‘felt very weak and low in spirits for want of food.’[51] Jemima T., a forty-two year-old domestic servant, told the clerk that she ‘has experienced at times a scarcity of both food and clothing.’[52] Making a pointed connection between the condition of her body and her economic circumstances, Susannah E., twenty years old, explained that she had ‘been accustomed to hard fare and work, which has impaired her constitution.’[53] According to this patient, her body had been physically transformed by poor food and hard labor. Sarah W. connected her illness to

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unemployment, stating ‘that she has been very bad for this last month in consequence of being out of place before which time she had been accustomed to good hiring.’[54] Some patients revealed a certain fatalism concerning the relationships between their work, health, and poverty. Jane F., for example, was admitted to UCH in 1844 for ‘condensation of both lungs.’ At forty-five, she had been married for twenty-nine years. ‘For the first fourteen or fifteen years after her marriage she did nothing but attend to her domestic duties,’ but with more difficult times, she became a laundress, contributing wages to her family’s survival. Her willingness to work was accompanied by a willingness to sacrifice her needs for others. When her husband could not find work in his employment as a baker, she was ‘obliged to stint herself a little in order that her children might not suffer for want of anything.’ Yet Jane did not complain about her hardship: ‘She has been used to hard work all her life ... She says she always took things as they came and made the best of them.’[55]

As in the case of Jane F., for many married women staying out of pauperism was most often dependent upon the employment of the husband, and even if a husband was not the primary breadwinner in reality, the ideology was powerful enough that the emotional consequences of a man out of work could be significant. Many of the married patients noted that their general circumstances, and their health in particular, declined when their husbands were unemployed. Sarah B.’s husband, for example, was a carman. Since he had ‘been out of work ... she has lived badly, getting meat seldom.’[56] Similarly, Charlotte J.’s husband’s illness prevented him from working and the family from getting enough food.[57] Other women expressed that they were emotionally affected by their husbands’ unemployment. Catherine M. had ‘always enjoyed good health until lately, when her husband lost his employment and she experienced great depression of spirits.’[58] These cases suggest that the women could not earn enough by themselves to support their families, and patients made explicit connections between their lack of subsistence income and their declining health.

Just as patients blamed economic hardship as contributing to their ill health, so they blamed the environment. Many patients described unsanitary living conditions, in damp dwellings that lacked warmth. Wet and cold were especially significant in the case histories and were mentioned so frequently as causes of illness that the clerk often noted when a patient ‘has not got wet or been exposed to cold’ or ‘has not been exposed to cold or wet.’[59] In addition to being common-sense interpretations of illness (we still associate the discomfort of going out in cold and/or wet weather with catching cold), wet and cold as medical explanations for disease had a long history; they were key components in the tradition of Hippocratic and humoral medicine, and an excess of these elements was thought to produce an imbalance of the

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entire constitution.[60] In the humoral framework, women’s bodies themselves were thought to be wet and cold, whereas men’s were the more perfect hot and dry. The case histories suggest that these categories still had meaning for both patients and doctors. The language doctors used to describe the patients was often humoral – patients could be phlegmatic, plethoric, or sanguineous, for example – and the hospital practitioners continued to use treatments associated with a humoral understanding of the body, such as bleeding, blistering, and purging. For the patients, ‘getting wet in the feet’ [61] was mentioned as a frequent cause of the common cold, as was exposure to drafts. Catching cold, in turn, could translate into further symptoms. Sarah B., for example, ‘has been much exposed to cold and wet ... four days since she felt pain in her knee, afterwards in her ancle and soon both legs became so affected that she could not use either; she attributes the cause to sleeping in a damp bed.’[62] In an extreme case, Mary T., a fifty-three year-old cook, connected her ailments to constant dampness: ‘She has been living for the last 3 months in a damp kitchen which was always full of steam, her bedroom was also very damp, and moreover, she slept all this time in the same bed with a girl who had incontinence of urine, so that she says her night dress was generally dripping wet in the morning.’[63] Living under such conditions, and understanding disease to arise from these conditions, a poor woman would expect illness to be part of her ordinary existence.

As Ornella Moscucci has shown in her study of the development of gynecology in England, doctors in the 1830s and 1840s constructed links between unhealthy environmental conditions and an unhealthy female biology. Protheroe Smith, for example, a specialist in women’s diseases, ‘associated the gynaecological disorders of the poor with the insalubrious conditions of slum living, a relationship for which the constitutional theory of uterine disease provided the mediating link.’[64] Smith and other women’s doctors of the era believed that ‘residence in damp, cramped and unhealthy situations, long hours spent in close and ill-ventilated workshops depressed the tone of the general health; local uterine disorders, particularly of the functional kind, were commonly the result in women.’[65] This resonates with the testimony of medical men given before the various parliamentary committees and commissions investigating employment and sanitary conditions in the early Victorian years. These inquiries often focused on the connections between women’s ill (reproductive) health, their employment situations, and the state of their homes. Working women giving evidence before these commissions also stressed the unhealthy nature of their working and living environments.[66]

While menstruation itself was central to patient understandings of female biology, the intersection of menstruation with environmental elements was particularly significant in the patients’ descriptions of their

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ailments. Many patients linked menstrual problems to getting their feet wet or being exposed to cold. Mary C. stated that ‘five years ago [she] caught cold from getting wet through, the catamenia which were present at the time were stopped.’[67] In contrast, but still illustrating the connection drawn by the women between menstruation, environment, and illness, Julia T. indicated that her menses ‘have not always appeared regularly, but lately they have done so, and have been rather excessive in quantity – very much so at the last period which was just before the occurrence of this illness. She knows no cause for it, but says that she remembers getting her feet wet about a week before the commencement of the attack’ of rheumatism.[68] Maria R., who was admitted to UCH in 1835 for amenorrhea, claimed that her ailment was caused when she ‘caught cold from walking with bare feet on a brick floor about a year ago, since which the catamenial discharge has ceased.’[69] In some cases, it is clear a patient thought an illness itself resulted from the fact that she was menstruating at the time of being exposed to cold or wet. One woman, for example, related that she ‘caught cold from being drenched with water, during menstruation.’[70] Margaret L. stated that a few months before her admission ‘she supposed she caught cold, for the catamenia suddenly stopped.’[71] In another case, the patient indicated that her rheumatic symptoms from getting her feet wet disappeared when she began menstruating.[72]

These cases reflect the patients’ understanding of the interconnected nature of their bodily systems. The body’s processes – reproductive and non-reproductive – were thought to respond to the environment in certain ways, which then produced rheumatism, fevers, and other illnesses. These examples suggest that the patients connected regular menstruation to a healthy condition. Yet, they also show the perceived fragility of normal menstrual cycles and, by connection, the fragility of good health. Not only could menstruation be interrupted by stepping in a puddle or standing in a cold room, but this interruption would then affect the entire body. The ease and frequency with which women imagined wet and cold to affect their bodies, and particularly normal menstruation, lies in tension with their understanding of themselves as strong and robust. While many of the women saw themselves as usually healthy, their perceptions of disease indicate the fragility of that health.

While worrying about how material conditions affected their health, the patients at UCH also indicated that their personal relationships contributed to the state of their well-being. The cases illustrate that London working women connected a decline in health to poor domestic situations. For example, some women came to the hospital infected with venereal disease, reporting that they had contracted the infection from their husbands. Other women suffered from emotional and physical battering at the hands of their spouses and sweethearts. The circumstances of their

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home lives were closely linked to illness causation and the patients’ perceptions of what made them sick.

Eleven women attributed their ill health to contracting venereal diseases from their husbands. In the case of the shoebinder, Fanny P., the clerk wrote that ‘previous to the patient’s marriage her health had been always good, was very plump and strong. ... About 8 years since and very shortly after her marriage she contracted gonorrhea from her husband.’[73] Sarah R., who was suffering from hysteria, complained of her husband’s promiscuity, which finally resulted in her illness. The clerk noted that Sarah ‘has been in a delicate state of health for some years but more particularly since her marriage two years since not being on good terms with her husband who is a man of irregular habits. ... She caught gonorrhea from her husband.’[74] Most historical studies of venereal disease and marriage have addressed middle-class families, predominantly in the late Victorian and Edwardian periods. An aim of social purity and feminist campaigns from about 1870 until around the time of the First World War was to expose husbands who brought syphilis and gonorrhea home to their wives.[75] The evidence from the patient records suggests that the problem of venereal disease in marriage was prevalent in early Victorian working-class marriages, and had a significant impact on working women’s lives. Those who were admitted to the hospital, for example, could not follow their domestic or wage-earning employments. We need to pursue further how laboring women responded to venereal disease, and how it affected working-class marriages.

Along with venereal disease, married women blamed physical and mental abuse by their spouses as a cause of their declining health. Historians who have studied domestic violence have mostly used evidence from court cases and other legal sources to ground their analyses; the evidence from the hospital records supports and expands upon these analyses. The prevalence of alcohol in cases of spousal violence, the public nature of domestic abuse, and connections between economic instability and domestic violence, which Nancy Tomes, A. James Hammerton, and Anna Clark among others have discussed, are all present in the patient narratives.[76] The dressmaker Sarah G., for example, suffered economically from her husband being out of work and mentally and physically from his abuse. She ‘[h]as had but little food or drink this last month; her husband being out of employ ... her husband seems to have caused uneasiness, for when intoxicated he beats her very much.’[77] One woman actually used her occupation as a strategy to stay away from her husband. As a nurse, she ‘always endeavoured to keep her situation as long as possible, in order to avoid living with her husband who is a great drunkard and is in the habit of treating her very ill.’ She indicated that her illness, hysteria, was brought on with marriage, since which ‘she has been subject to fits which occur at regular intervals.’[78]

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In most cases where abuse was present, the clerk noted ‘ill treatment.’ Winifred M., who at forty-eight had had thirteen children, related that ‘in consequence of ill treatment from her husband, she has lived rather a hard life.’[79] It is unclear whether this coded language was the woman’s own, or the clerk’s transcription. Ann S., however, who was admitted to UCH in 1835, was precise about her ‘ill treatment’: she had been ‘pushed while pregnant against a table by her husband and miscarried.’[80] Elizabeth G., a forty-six year-old woman, told the clerk that she had had a good life until her marriage two years before her admission to UCH in May of 1843. According to Elizabeth, her husband ‘treated her very cruelly’ as a result of his ‘intemperate habits.’ She claimed that her illness was exacerbated ‘from being frightened by her husband.’[81]

The case histories are clear that domestic violence had damaging effects on women’s physical and emotional health. Less extreme domestic occurrences also are referred to in the patients’ narratives as causes of illness. Patients mentioned things that provoked fear, for example, as prevalent causes of epilepsy and hysteria. Ann S., a twenty-two year-old servant, stated in 1835 ‘that about 6 years ago she was very much frightened by a rat which caused her to have a fit and she has had them more or less frequently ever since.’[82] Patients described more significant ‘frights’ as well. Jane H., for instance, had always menstruated regularly until ‘she saw some prisoners going off in custody from the Marylebone Police Office to jail which occasioned a feeling of coldness all over her body with depression of spirits since which time the catamenia have not appeared till about a week back when they were in very small quantities.’[83] As with wet and cold, fright was perceived as the cause of suppressed menstruation, which then would cause other problems. Susannah M. stopped menstruating ‘suddenly when she was frightened by [her] daughter having stolen a table cloth which produced a sensation of great debility and trembling after which she lost all disposition to go about her ordinary affairs’ as a charwoman.[84] Elizabeth G., mentioned above as a victim of domestic abuse, also indicated that her menstrual cycle was interrupted when she was frightened by her husband.[85]

According to the patient narratives, poor economic circumstances or difficulties with family could lead to emotional problems which then brought on illness. In one case, Anne H. ‘came into the hospital in a very melancholy state, talks very incoherently and is wishing to go home to see her children ... the only cause to which her attack can be attributed is anxiety produced by her husband being out of work.’[86] The sixteen year-old servant of all work, Susan B., tried to commit suicide through laudanum poisoning because of bad family and work circumstances:

She states that her stepmother is unkind and makes her unhappy whenever she goes home. Was discharged from her last situation on

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Tuesday night, and went to her father’s lodgings but slept on the stairs fearing to enter the room because of the stepmother. Yesterday she spent at a sister’s house who could not afford her lodging for another night, and there she contemplated suicide by means of laudanum.[87]

This young woman saw herself faced with few choices when confronted with the combination of unemployment, family instability, and poverty. Other women attempted suicide because of family disagreements. Mary J., for example, was thrown out of the home of the relatives with whom she was living; ‘at this her anger and dejection were such that she determined to destroy herself.’[88]

Some patients, however, indicated that illness was brought on as a result of close family relationships. Sadness at the loss of a family member or spouse was cited as a cause for the decline of health. Elizabeth S. ‘fretted much’ when her husband died, and she became violently ill with shaking and palpitations.[89] The description of Dinah T.’s loss is quite moving: ‘About 6 years ago she lost her husband, fretted very much and has since been frequently attacked with a dull aching pain in the region of the heart.’ Dinah was only twenty-seven when she was admitted to UCH.[90] Catherine M. attributed her sensation of weakness to ‘great depression of mind caused by the death of her first child.’[91]

Along with conditions at home, patients described the work environment as potentially detrimental to their health. The 1830s and 1840s saw many social and political investigations into the conditions of labor and living among the poor, which resulted in legislative restrictions on children’s and women’s labor in textile factories and in mines. While most of the focus of the inquiries was directed toward factories and mines, investigators were also concerned with the dreadful conditions of London women’s work in dressmaking and millinery, although no regulations followed. The majority of women working in London did not draw the attention of political reformers, as their occupations were seen to fall within the realm of proper work for women. While jobs like service and laundry were not problematized by those with the power to suggest change, the women themselves identified many health problems resulting from their work.[92] Stone kitchen floors seem to have been a recurrent problem for servants. A housemaid suffering from dyspepsia stated that ‘She has in her employments been exposed to damp and cold, her feet have often been wet and almost always cold in winter from the floor of the kitchen being of stone.’[93] Rheumatism was blamed on the dampness of stones on which servants had to kneel. Mary Ann R., a thirty-one year-old servant, narrated that ‘kneeling upon stone floors her right knee swelled much and was very painful. She attributed it to the kneeling.’[94] Additionally, ‘housemaid’s knee’ – a condition in which the knee swelled, or produced a sore – was an actual diagnosis. Eliza A. suffered from housemaid’s knee: since ‘she commenced the work of house

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maid has been continually employed kneeling, cleaning floors, stairs, &c.’[95] Servants and laundresses also complained of the damp environments in which they had to do washing. Rebecca S., a housemaid, developed bronchitis from washing: she was ‘exposed to cold and wet from washing, from which a severe cold came on with tenderness of the abdomen and constipation.’[96] A laundress ‘caught cold from standing in the laundry with wet feet.’[97] Washing in damp was also blamed for such ailments as scarlatina and rheumatism.

Environmental factors at work posed problems for other women workers. Sarah S., for example, saw significance in the fact that ‘since her marriage she has had a very sedentary life at needle work in a close and damp situation.’[98] Like Ann S., a fruit seller in the streets, market women and hawkers were ‘accustomed to live upon bad food and exposure to the vicissitudes of the weather.’[99] The servant Mary C. blamed a current illness on her previous employment: ‘Two years ago in consequence of keeping a stall in the street she frequently got wet.’[100] These descriptions indicate that the patients were not inured to the conditions under which they worked; they thought that their occupations were unhealthy and potentially dangerous. Yet women had few choices for employment in London and took what they could get.

Female patients also blamed their poor health directly on their labor and their treatment by employers. In the one instance of a woman engaged in factory work, the patient’s illness was clearly work related: ‘On the morning of admission in attempting to remove a piece of cotton from the machinery the hand got entangled in one of the wheels.’[101] Servants and other women, such as charwomen and nurses, who had to do physical labor, complained that their diseases resulted from overwork. Others simply thought that hard labor or work that was too strenuous for their bodies caused their illnesses. Martha T. believed her health had declined because her situation in service ‘was too hard for her, in consequence of which her strength is reduced somewhat; it seems to have caused great weakness in the lumbar region and occasionally feels pain in the chest.’[102] The predominant illnesses assigned to hard work were rheumatism, gastro-intestinal disorders, menstrual disorders, and especially anemia.

Some women indicated that their ability to do their work was itself a sign of their health. When labor became difficult, it marked a decline in physical well-being. One housemaid stated that ‘She always had very excellent health before this attack [of enteritis] and was very strong, able to do her work without being fatigued.’[103] The evidence, however, also reveals that women were unwilling to give up their employments when ill, for fear of losing wages, or the job altogether. Jane R.’s narrative hints that her anemia resulted from her labor; yet she was loath to stop working even when not feeling well. She stated that her ‘present attack commenced about

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6 months since, very shortly after she went into her situation; notwithstanding which she continued at her work, it was very laborious, frequently having to walk about with stationery and when in the house had a good deal of going up and down stairs.’[104] Women’s descriptions of the effects their employments had on their health illustrate that their financial survival and their physical well-being could often be in conflict. The earning of wages entailed a sacrifice of the body that not all women could withstand.

The University College Hospital female patients attributed their illnesses to social and environmental causes with which they came into contact on an everyday basis. Their poverty broke down their resistance to illnesses and prevented them from moving to better accommodation or choosing drier, warmer, and less taxing occupations. Many women worked or lived in damp and/or cold conditions, and saw these conditions as the root of their rheumatism, or bronchitis, or phthisis. The cases show that some women were in unhappy marriages and had to deal with emotional traumas related to family and employment. Spousal abuse caused long-lasting physical and mental suffering, as did fear, grief, and loss in other domestic contexts. Although the UCH patients often saw themselves as naturally strong and robust, their narratives also reveal the ease with which they could become ill. The ways they conceptualized disease, combined with their poor living and working conditions, made London working women’s self-perception of their bodies as vigorous and sturdy extremely tenuous.

The patients named social and environmental factors, as opposed to biology and the forces of their reproductive functions, as the primary causes making them sick. Although women and their doctors gave attention to irregular menstruation as playing a part in illness, it was rarely in isolation. Nowhere in the case histories is it suggested that menstruation alone was debilitating for women, or that it should prevent them from completing their domestic and employment tasks. Rather, the UCH doctors and their patients approached the reproductive system – and specifically the menstrual cycle – as one system intertwined with the other systems in the body. Disruptions to the normal functioning of one could affect the functioning of others.

The conventional historical notion that medical men determined that female reproductive functions made women inherently weak and unstable does not seem to have applied to women of the laboring classes – neither for the doctors, nor for their patients. Although the social ideal held that all women should not work outside the home, the reality of the UCH patients’ lives was that they had to labor in order to survive. This reality would have been clear to their doctors, who would most likely have tried their best to facilitate their patients’ return to their livelihoods. The female patients made it clear that healthiness was equated with strength, and perceived delicacy and weakness to be signs of something abnormal, rather than a preferred state of femininity.

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Acknowledgements

I want to thank University College London Library (UCLL) for permission to cite the records of University College Hospital on which this analysis is based. I would also like to thank Jeff Cox and Susan Lawrence, who offered valuable suggestions on early drafts of this essay, and the readers for the Women’s History Review for their very helpful comments. Lucinda McCray Beier and Heather Munro Prescott, as commentator and chair at the 2001 American Historical Association session at which I presented some of this material, pointed to useful directions to sharpen the analysis. Students in my ‘Gender, Science, and Medicine’ classes have kept my thinking on the issues fresh.

Notes

[1] Lesley Doyal (1995) What Makes Women Sick: gender and the political economy of health (New Brunswick: Rutgers University Press).

[2] Medical journals such as the Lancet and the British Medical Journal, and the many popular and technical nineteenth-century medical works on female health, have been useful sources for historians.

[3] See, for example, Carroll Smith-Rosenberg & Charles Rosenberg (1973) The Female Animal: medical and biological views of woman and her role in nineteenth-century America, Journal of American History, 60, pp. 332-356; Barbara Ehrenreich & Deidre English (1973) Complaints and Disorders: the sexual politics of sickness. Glass Mountain Pamphlet no. 2 (New York: Feminist Press), and (1978) For Her Own Good: 150 years of the experts’ advice to women (New York: Anchor Books); Ornella Moscucci (1990) The Science of Woman: gynaecology and gender in England 1800-1929 (New York: Cambridge University Press); Elaine Showalter (1985) The Female Malady: women, madness, and English culture, 1830-1980 (New York: Penguin); and Mary Poovey (1988) Scenes of an Indelicate Character: the medical treatment of Victorian women, in Uneven Developments: the ideological work of gender in mid-Victorian England, pp. 24-50 (Chicago: University of Chicago Press).

[4] Guenter B. Risse & John Harley Warner demonstrated the rich possibilities of patient records for historians in a 1992 article. Their point that ‘the information preserved in hospital case books about patients’ perceptions of illness and medical treatment’ is ‘[e]specially promising, yet little explored’ still stands. Risse & Warner (1992) Reconstructing Clinical Activities: patient records in medical history, Social History of Medicine, 5, p. 190. Some historians who recently have made use of patient cases include Heather Munro Prescott (1998) A Doctor of their Own: the history of adolescent medicine (Cambridge, MA: Harvard University Press); and Regina Morantz Sanchez (1999) Conduct Unbecoming a Woman: medicine on trial in turn-of-the-century Brooklyn (New York: Oxford University Press). Patient case records have proven very useful to historians of psychiatry. See, for

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example, Anne Digby (1985) Madness, Morality, and Medicine: a study of the York Retreat, 1796-1914 (New York: Cambridge University Press); Elizabeth Lunbeck (1994) The Psychiatric Persuasion: knowledge, gender, and power in modern America (Princeton: Princeton University Press); and Nancy M. Theriot (1993) Women’s Voices in Nineteenth-Century Medical Discourse: a step toward deconstructing science, Signs, 19, pp. 1-31. Several of the unpublished papers from the conference ‘Narrative, Disease, and History,’ held at Yale University in 1993, also illustrate the exciting possibilities of using case histories. I want to thank Susan Lawrence, a participant in the conference, for allowing me to consult these papers. There is also interesting and important work being done in the cultural study of medical case records. For an introduction, see ‘The Art of the Case History,’ special issue of Literature and Medicine, 11 (1992); and Julia Epstein (1995) Altered Conditions: disease, medicine, and storytelling (New York: Routledge).

[5] The catalogue for the University College Hospital Medical Records (UCH/MR) lists twenty-nine female case books: one volume cannot be found; one has most of the pages missing; and one is actually a volume of male cases.

[6] Some of the cases I am counting as admissions are actually readmissions. As these were not differentiated in any systematic fashion, I have included as ‘admissions’ all new entries on a particular patient. For example, in some books, a patient’s readmission is included with her original admission. I have counted these cases only once.

[7] John Elliotson is perhaps the most well known through his connection with mesmerism. See Alison Winter (1998) Mesmerized: powers of mind in Victorian Britain (Chicago: University of Chicago Press). There were other medical men practicing at UCH during this period whose case books do not survive.

[8] See, for example, Norman Jewson (1974) Medical Knowledge and the Patronage System in Eighteenth Century England, Sociology, 8, pp. 369-385; Roy Porter (Ed.) (1985) Patients and Practitioners: lay perceptions of medicine in pre-industrial society (New York: Cambridge University Press); Dorothy Porter & Roy Porter (1989) Patient’s Progress: doctors and doctoring in eighteenth-century England (Oxford: Polity Press), Dorothy Porter & Roy Porter (1988) In Sickness and in Health: the British experience, 1650-1850 (London: Fourth Estate); Irvine Loudon (1986) Medical Care and the General Practitioner, 1750-1850 (New York: Oxford University Press); and Mary Fissell (1991) Patients, Power and the Poor in Eighteenth-century Bristol (New York: Cambridge University Press).

[9] See Risse & Warner, ‘Reconstructing Clinical Activities,’ for a discussion of the ways medical records have been used by historians.

[10] Barbara Duden (1991) The Woman beneath the Skin: a doctor’s patients in eighteenth-century Germany, trans. Thomas Dunlap (Cambridge MA: Harvard University Press).

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[11] N.D. Jewson (1976) The Disappearance of the Sick-Man from Medical Cosmology, 1770-1870, Sociology, 10, pp. 225-244.

[12] Mary Fissell (1991) The Disappearance of the Patient’s Narrative and the Invention of Hospital Medicine, in Roger French & Andrew Wear (Eds) British Medicine in an Age of Reform, p. 93 (New York: Routledge).

[13] This is especially the case in Ehrenreich & English, Complaints and Disorder; and Ehrenreich & English, For Her Own Good. Historians are not the only scholars who take this approach. Much of the contemporary feminist literature on women and medicine also presents women as victims of a professional medicine that has stripped birth and healing power from women. See, for example, studies of reproductive technologies by Barbara Katz Rothman (1991, new edition) In Labor: women and power in the birthplace (New York: W.W. Norton); Barbara Katz Rothman (1989) Recreating Motherhood: ideology and technology in a patriarchal society (New York: W.W. Norton); and Gena Corea (1985) The Mother Machine: reproductive technologies from artificial insemination to artificial wombs (New York: Harper & Row).

[14] For example, Moscucci, Science of Woman; Ehrenreich & English, Complaints and Disorders; Ehrenreich & English, For Her Own Good; and Poovey, ‘Scenes of an Indelicate Character.’

[15] Theriot, ‘Women’s Voices,’ p. 2, emphasis in original.

[16] See, among others, Poovey, ‘Scenes of an Indelicate Character’; Judith Walkowitz (1980) Prostitution and Victorian Society: women, class, and the state (New York: Cambridge University Press); and Catherine Gallagher & Thomas Laqueur (Eds) (1987) The Making of the Modern Body: sexuality and society in the nineteenth century (Berkeley: University of California Press).

[17] UCH Minutes of the Medical Committee, November 1834 to December 1848, UCLL, UCH/MIN/1/1. The Minutes indicate that there was a regulation book for clerks and dressers, but I was unable to locate it.

[18] Subsequently, I will use the term ‘clerk’ to refer to both clerks and dressers.

[19] These are my own labels. Throughout the case books, the clerks sometimes used headings for various sections – these included history, medical history, heredity, previous illnesses, present symptoms, treatment. These labels were used unsystematically, however.

[20] While I am not as skeptical as Joan Scott about our ability as historians to understand past experiences outside of language, I am sensitive to the challenges of mediated sources. See Joan W. Scott, ‘Experience,’ in Judith Butler & Joan W. Scott (Eds) (1992) Feminists Theorize the Political, pp. 22-40 (New York: Routledge).

[21] Risse & Warner, ‘Reconstructing Clinical Activities,’ p. 190.

[22] Geoffrey Rivett (1986) The Development of the London Hospital System, 1823-1982 (London: King’s Fund Publishing Office).

[23] UCLL, UCH, Annual Reports, 1833-47. Lists of Subscribers.

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[24] UCLL, UCH, Third Annual Report, 1 November 1837, p. 6.

[25] UCLL, UCH, First Annual Report, 1 November 1 1835, pp. 3-4; Eleventh Annual Report, 1845-46, p. 8.

[26] UCLL, UCH, Annual Reports, 1833-47.

[27] The occupations I have included as servants are cook, domestic servant, housemaid, maid of all work, housekeeper, kitchen maid, lady’s maid, servant, service, servant of all work, under maid, and nurse maid.

[28] For a thorough discussion of women’s work in London during these years, see Sally Alexander (1995) Women’s Work in Nineteenth-century London: a study of the years 1820-1860s, in Becoming a Woman and Other Essays in 19th and 20th Century Feminist History, pp. 3-55 (New York: New York University Press; originally published in 1976).

[29] Additionally, a very small percentage of the women said they were separated (0.5%).

[30] Fissell, Patients, Power, and the Poor.

[31] See especially, Showalter, The Female Malady; and Ehrenreich & English, Complaints and Disorders.

[32] Samuel Mason (1845) The Philosophy of Female Health, quoted in Pat Jalland & John Hooper (Eds) (1986) Women from Birth to Death: the female life cycle in Britain, 1830-1914, p. 21 (Brighton: Harvester Press).

[33] John Forbes, Alexander Tweedie & John Connolly (Eds) (1846 revised from the London edition) The Cyclopaedia of Practical Medicine, with additions by Robley Dunglison, p. 308 (Philadelphia: Blanchard & Lee).

[34] E.J. Tilt (1851) On the Preservation of the Health of Women at the Critical Periods of Life, p. 52 (London: John Churchill). The chapters of this book are entitled ‘On the Right Management of Women before the First Appearance of Menstruation’; ‘On the Right Management of Women at First Menstruation, and During the Continuance of that Function’; ‘On the Right Management of Women during Matrimonial Life,’ essentially a chapter about the relationship between pregnancy and menstruation; ‘On the Management of Women at, and after the Cessation of, Menstruation’; and ‘On the Treatment of Diseases at the Change of Life,’ meaning how the cessation of menstruation affected the body.

[35] Sally Shuttleworth (1990) Female Circulation: medical discourse and popular advertising in the mid-Victorian era, in Mary Jacobus, Evelyn Fox Keller & Sally Shuttleworth (Eds) Body/Politics: women and the discourses of science, p. 47 (New York: Routledge).

[36] Review of Samuel Ashwell’s A Practical Treatise on the Diseases Peculiar to Women, Part II, Medico-Chirugical Review, 1 October 1843, p. 357.

[37] See, for example, Londa Schiebinger (1989) The Mind Has No Sex? Women in the Origins of Modern Science (Cambridge, MA: Harvard University Press), and Thomas Laqueur (1990) Making Sex: body and gender from the Greeks to Freud, pp. 149-192 (Cambridge, MA: Harvard University Press).

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[38] Irvine Loudon (1997) Midwives and the Quality of Maternal Care, in Hilary Marland & Anne Marie Rafferty (Eds) Midwives, Society and Childbirth: debates and controversies in the modern period, p. 183 (New York: Routledge).

[39] I have not examined medical cases of middle-class women. These would come from private records of individual doctors’ cases, as the only people to attend hospitals in the early Victorian years were the poor.

[40] UCLL, UCH/MR/1/8, Thomson, p. 181.

[41] UCLL, UCH/MR/1/9, Elliotson, p. 46.

[42] UCLL, UCH/MR/1/58, Taylor, np.

[43] UCLL, UCH/MR/1/37, Taylor, p. 41.


[45] Theriot, ‘Women’s Voices,’ p. 20.

[46] Ibid., p. 24.

[47] Emily Martin (1992) offers a useful analysis of the relationships between late twentieth-century medical models of menstruation and the ways in which middle- and working-class women talk about menstruation in The Woman in the Body: a cultural analysis of reproduction, chapter 6, ‘Menstruation, Work, and Class,’ pp. 92-112 (Boston: Beacon Press).

[48] UCLL, UCH/MR/1/27, Williams, p. 99.

[49] Ibid., p. 131.

[50] This phrase is used throughout the case books.









[59] UCLL, UCH/MR/1/18, Thomson, pp. 8 and 28.

[60] For a larger analysis of the place of wet and cold in patient narratives, see Mary Fissell, ‘The Disappearance of the Patient’s Narrative,’ pp. 92-109. For a nice discussion of the basics of humoral medicine, see Nancy Sirasi (1990) Physiological and Anatomical Knowledge, chapter four in Medieval and Early Renaissance Medicine: an introduction to knowledge and practice, pp. 78-114 (Chicago: University of Chicago Press).



[63] UCLL, UCH/MR/1/56, Thomson, np.

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[64] Moscucci, The Science of Woman, p. 83.

[65] Ibid.

[66] For a larger discussion of these issues, see Marjorie Levine-Clark (1997) Body Languages of Labor: the politics of women’s work and health in early Victorian England, chapters 1 and 2, pp. 24-141, PhD dissertation, University of Iowa.









[75] Josephine Butler’s crusade against the Contagious Diseases Acts and Christabel Pankhurst’s ‘The Great Scourge’ are two famous moments in this context. For histories of these issues see, for example, Gail Savage (1990) ‘The Wilful Communication of a Loathsome Disease’: marital conflict and venereal disease in Victorian England, Victorian Studies, 34, pp. 35-54; Susan Kingsley Kent (1987) Sex and Suffrage in Britain, 1860-1914 (Princeton: Princeton University Press); Lucy Bland (1995) Banishing the Beast: sexuality and the early feminists (New York: New Press); Frank Mort (1987) Dangerous Sexualities: medico-moral politics in England since 1830 (New York: Routledge & Kegan Paul); and Walkowitz, Prostitution and Victorian Society.

[76] See, for example, Nancy Tomes (1978) A ‘Torrent of Abuse’: crimes of violence between working-class men and women in London, 1840-1875, Journal of Social History, 11, pp. 327-345; A. James Hammerton (1992) Cruelty and Companionship: conflict in nineteenth-century married life (New York: Routledge); and Anna Clark (1995) The Struggle for the Breeches: gender and the making of the British working class (Berkeley: University of California Press).








[84] Ibid., p. 154.


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[87] UCLL, UCH/MR/1/9, Elliotson, p. 150.



[90] Ibid., p. 109.

[91] Ibid., p. 166.

[92] For a fuller comparison of parliamentary definitions of unhealthy women’s work and women’s own definitions of unhealthy work, see Levine-Clark, ‘Body Languages of Labor.’

[93] Ibid., p. 99.

[94] UCLL, UCH/MR/1/60, Liston, p. 223.

[95] Ibid., p. 39.

[96] UCLL, UCH/MR/1/21, Carswell, p. 154.





[101] UCLL, UCH/MR/1/60, Liston, p. 110.




MARJORIE LEVINE-CLARK is assistant professor in the Department of History, University of Colorado at Denver, Campus Box 182, PO Box 173364, Denver, CO 80217, USA ([email protected]). She has published ‘Engendering Relief: women, ablebodiedness and the new Poor Law in Early Victorian England’, in the Journal of Women’s History (Winter 2000), and ‘Dysfunctional Domesticity: female insanity and family relationships among the West Riding poor, 1834-1852’, in the Journal of Family History (July 2000). She is currently completing her book manuscript, Body Languages of Labor: the politics of women’s health and work in early Victorian England, and beginning a project examining gender, poverty and welfare in England’s Black Country in the late nineteenth and early twentieth centuries.

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Testing the Reproductive Hypothesis: or what made working-class women sick in early Victorian London

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Transcript of Testing the Reproductive Hypothesis: or what made working-class women sick in early Victorian London