By midcentury dissatisfaction with established medical practice had reached astonishing proportions; doctors had good reason to feel on the defensive. “The practice, or so-called science of medicine, has been little else than one of experiment,” observed the health reformer Mrs. Marie Louise Shew in a scathing indictment. Standard medical therapeutics, she claimed, had hitherto been characterized by “uncertainty” and “chance.” Little progress had been made in alleviating the sufferings of mankind.² “Why,” asked Shew’s colleague Mary Gove Nichols, “are we sick? Why cannot the doctors cure us?” Men, women, and society had sought a cure so long in vain that they began to distrust their doctors. “We are tired of professions and promises.”³

Heroic methods of treatment—bleeding, purging, and puking—were indeed painful and dangerous, and the American public, sick to death of bloodletting and calomel, had reason to rebel. Yet for decades regularly trained physicians could muster only a weak and ineffectual response. Between 1800 and 1840, innovative research was being conducted in Europe, most notably in France by the so-called Paris school. Investigators painstakingly correlated bedside symptoms with lesions observed during autopsies. For the first time, they began to distinguish clearly between various diseases. Indeed, French clinicians became so skeptical of accepted therapeutics that they helped to discredit the assumptions of heroic medicine, which relied on monistic approaches to disease—the assumption that every sickness could be attributed to one ultimate cause—and distinguished only among symptoms rather than discrete illnesses. Unfortunately, in taking the first hesitant steps toward a concept of specific etiology, these physicians undermined public and professional confidence in older therapies before they were able to put anything in their place. This “relatively cold-blooded” approach to human illness, as Richard Shryock has wryly pointed out, was “of little aid to the sick.”⁴ The eventual result was occasional therapeutic nihilism among doctors and public revulsion against the harshness of regular practice.

The discovery of anesthesia at the end of the 1840s compounded the profession’s difficulties by calling into question older concepts of professionalism. If professionalism is defined as involving not only licensing and standards but also a set of values and prescriptions for behavior that help people to balance conflicting occupational demands, we can see why this occurred. Nineteenth-century professional ideas reflected the social structure, values, and technical capabilities of the age.⁵ As researchers have shown, before anesthesia the possible necessity of inflicting physical pain on patients was a part of the daily reality of professional practice and constituted an integral feature of the self-image and ideology of physicians. Physicians and surgeons sought to balance empathy with cool detachment; the best surgeon knew that the physician’s first responsibility was to cure, not to soothe. One author has observed that the two professional prerequisites for a surgeon were a strong stomach and a willingness to “cut like an executioner.”⁶

John Ware used this need for detachment as an argument against teaching women medicine. According to him, females could not achieve such emotional distance. Ware’s views were so typical that women themselves occasionally shared them. “The Past, with the lancet, and poison, and operative surgery,” wrote Mary Gove Nichols, a hydropathic physician, feminist, and health reformer, “did not insult woman by asking her to become a physician; and the Past has not asked her to become hangman, general, or jailer. We may well excuse all believers in Allopathy, if they judge woman unfit for the profession.”⁷ The use of ether and chloroform, however, would quickly undermine a major objection to women practitioners while “feminizing” medicine by calling into question the “heroic” image of the physician.⁸

These important changes in medical science and technology were accompanied by institutional growing pains. Efforts to raise standards floundered in the antebellum period. One factor contributing to the problem was the proliferation of proprietary medical schools, which were set up by private physicians to provide an educational program, not for its own sake, but for their profit. The ensuing intense competition for students lowered educational quality. Clinical facilities remained meagre or nonexistent. Eventually, even the university-affiliated colleges of medicine could not attract students without reducing their requirements. It became possible to turn oneself into a doctor in less than a year merely by attending two terms of didactic lectures. Scores of young men held a medical degree with little or no clinical experience and often without ever having witnessed a single childbirth. The degeneration of medical education in the first half of the nineteenth century made a mockery of physicians’ claims to superior skill in the lying-in chamber.

Jacksonian antielitism added to the profession’s difficulties, as hostility to all professional distinctions became a featured aspect of American political rhetoric. Beginning around 1830, most states responded by abolishing restrictive licensing legislation, which already had proved difficult to enforce. Although the American Medical Association and the New York Academy of Medicine were founded in 1846 to counter such trends, there was only slow progress in medical education until the end of the century.⁹

Probably none of the aforementioned problems bothered physicians as much as the rise of sectarianism and the proliferation of quackery. Although these two phenomena were different, regular physicians often defiantly lumped them together. Physicians looked on helplessly as the habit of self-dosing encouraged the small-scale patent medicine industry to adopt aggressive methods of advertising and thus emerge as a million-dollar business at the end of the nineteenth century.

Sectarians presented a different challenge. Responding in part to the growing dissatisfaction with heroic medicine, the followers of several new medical systems began to compete with the regular profession for public patronage, legitimacy, and authority. Some of these sects opposed the physician’s heroic methods and use of drugs and substituted for them the belief that only nature should do the healing. Hydropaths, for example, used only water internally, and externally in the form of baths and hot and cold compresses, shunning surgery and drugs altogether. Others, like the Botanics, later known as Eclectics, substituted so-called natural remedies for chemical and mineral ones. Homeopaths, although they used a variety of drugs, believed in such miniscule doses that their prescriptions had no deleterious effect—and possibly no effect at all. Like other sectarians, they too believed strongly in the healing powers of nature.¹⁰

In time these sectarians formed their own professional institutions—schools, journals, and societies. Favoring the popular diffusion of professional knowledge, and respecting women’s enhanced responsibilities in the family, their schools often welcomed women students, and consequently middle-class women initially gravitated to sectarian medicine. Many of the first generation of women doctors received their degrees from sectarian institutions. The challenge posed by sectarian medicine to older concepts of professionalism worked in favor of women. Paradoxically, in the mid-nineteenth century the abandonment of licensing legislation and the ease of access to a medical degree actually served to maintain a professional identity for all medical practitioners by conferring the title of doctor on a large proportion of them. This temporary fluidity allowed women who wished to achieve professional status to do so before definitions of professionalism crystallized once more.¹¹

The health-reform movement provided a different alternative to a dissatisfied public, and it grew and flourished in the atmosphere created by vociferous debate between sectarians and regulars over more humane methods of treatment. Beginning in the antebellum period, self-help in health matters, public hygiene, dietary reform, temperance, hydro-therapy, and physiological instruction merged as ingredients in a coherent and articulate campaign to save the nation by combating the ill-health of its citizenry. Although such attention to personal health and hygiene was not wholly original, never before had the regard for good health given rise to such widespread public activity.¹²

In the modernizing world of the nineteenth century, health reformers played a critical role in promoting the assumption that men and women were responsible for their own health, the health of their families and the health of society at large. Itinerant speakers lecturing to enthusiastic audiences and dedicated to furthering common knowledge of health and hygiene traversed the cities and towns of the North and West. Hundreds of heuristic tracts instructed eager readers in the “laws of life.” A handful of journals kept men and women informed of new developments. The popular Water-Cure Journal, for example, boasted 10,000 subscribers in 1849, the second year of its publication. ¹³

The concern with hygiene was an integral part of the antebellum reformist world view. The popularity of both sectarian medicine and health reform helped to shape the character of the midnineteenth-century reform consciousness. Indeed, the health crusade converged with several better-known radical concerns. Historians have been quick to point out this identity of ideas and personnel. Abolitionist speakers, for example, lodged at health-reform boarding houses, and a large number of women’s-rights advocates followed some form of Sylvester Graham’s vegetarian diet. Oberlin College, familiar as a breeding ground for abolitionism and women’s rights, adopted strict vegetarianism in its dining-room in 1835. Asa Mahan, the college’s president, put a “reformation in food, drink, and dress” high on the list of important causes. ¹⁴

A cursory glance at the men and women who actively promoted the health revolution suggests that, like other reformers, they came from the Northeastern, predominantly middle-class sectors of the American population. Sylvester Graham began his career in New Jersey as a Presbyterian minister and temperance lecturer. William A. Alcott, cousin of Bronson, was a thoughtful, Yale-trained physician. Joel Shew and Russell Trail graduated from regular medical schools in New York. James Caleb Jackson was the son of a yeoman farmer in upstate New York. Mary Gove Nichols became a teacher in Maine. Rachel Brooks Gleason graduated from New York’s Central Eclectic School of Medicine and ran a water-cure establishment with her physician husband. Paulina Wright Davis and Elizabeth Oakes Smith both hailed from prominent New York landholding families. Harriot Hunt’s father, a skilled navigator, invested his small capital in Boston’s commercial shipping industry. Lydia Folger Fowler, wife of the phrenologist publisher Lorenzo, was the second woman to receive a medical degree in the United States. A descendant of the Puritan settlers of Nantucket and a distant cousin of the astronomer Maria Mitchell, Lydia’s father was a manufacturer, a ship-owner, and a selectman of his native town. An intensive study of the rank and file of the Boston Ladies Physiological Society found that the large majority were predominantly the wives and mothers of Boston’s middle class.¹⁵

A shared theme of all health advocates was the inhibition of disease through the teaching of the laws of physiology and hygiene. Over and over again they argued that disease was preventable; that it was up to the individual to keep himself well. No longer were sickness and death to be tolerated with a stoicism and resignation that contrasted the limited moral choices of man with the all-powerful inscrutability of God. “Many people,” Mary Gove Nichols observed, “seem to think that all diseases are immediate visitations from the Almighty, arising from no cause but his immediate dispensation.... Many seem to have no idea that there are established laws with respect to life and health, and that the transgression of these laws is followed by disease.”¹⁶

Sylvester Graham, Nichols’s mentor, agreed that before people attributed disease to the Supreme Being who loved them, they must look to their own bad habits. Graham’s disciple Marie Louise Shew, whose husband edited the Water-Cure Journal, similarly warned against the “unwise, irrational, and unphilosophical” tendency of mankind to regard illness as “the infliction of Divine Providence.” God’s true design was for man “as a rule” to live in good health to a ripe old age. Human beings could affect the future by manipulating the environment according to nature’s laws and by gaining conscious control of themselves.¹⁷

Implicit in the health reformers’ theory of sickness was the idea of self-help. Disease resulted from the remedial effort of Nature to overcome or cast out of the body some impurity or poison which interfered with the functions of life.¹⁸ Since man was naturally healthy, to keep well he needed only to avoid unwise practices, such as eating the wrong foods and losing control of his “passions.” Knowledge of his own physical nature would make men free. “People,” announced Mrs. Shew, “must learn to think for themselves.” Ignorance could no longer be offered as an excuse for illness, agreed Nichols.¹⁹

Reformers accused the regular medical profession of making “no effort to remove the causes of disease,” while “vainly” endeavoring “to cure conditions, while causes remain. We even have reason to believe,” argued Dr. Ellen M. Snow, “that they have greatly multiplied disease by the use of poisonous drugs.” In a chilling denunciation of the dependence of the people on physicians, she declared:

In a flurry of antielitist rhetoric, health reformers deplored the complicated language of most medical journals. “Reader,” warned the editor of the Water-Cure Journal, “if you cannot understand what an author is writing about, you may reasonably presume he does not know himself.” “I would have the highest science, clothed in words, that the people can understand,” wrote Aurelia Raymond, in her graduate thesis at the Female Medical College of Pennsylvania. “I have studied medicine because I am one of the people ... to enter my protest against the exclusiveness, which sets itself up as something superior to the people....”²¹

Such accusations did scant justice to the more enlightened members of the regular medical profession. Physicians had long since recognized the value of increasing public knowledge of anatomy, physiology, and hygiene. Yet the rhetoric of the health reformers proved more congenial to the public temperament than the somber empiricism of the regulars which at the moment lacked application to treatment while it discredited heroic methods. Borrowing from the vocabulary of Christian perfectionism to make their point, popular lecturers like Sylvester Graham, William Andrus Alcott, and Mary Gove Nichols succeeded in making health reform a moral imperative. ²²

Public lectures on physiology and hygiene became an important tool in the campaign to combat ignorance. In 1837 the American Physiological Society was founded in Boston to promote health and longevity by dispelling ignorance of physiological laws. William Alcott was the society’s first president, and other prominent health reformers, including Sylvester Graham and David Cambell, were also involved. During its first year the society sponsored a number of lectures given by prominent physicians and reformers, including Graham and J.V.C. Smith, a regular physician and the editor of the Boston Medical and Surgical Journal.²³

Although the health-reform movement attracted both men and women, it was to the middle-class woman, by virtue of her new role in an increasingly complex society, that many of the health reformers addressed themselves. Almost a third of the members of the American Physiological Society, for example, were women. At its second annual meeting the new organization acknowledged women’s central role in promoting good health in the following resolution:

The spread of female education received the enthusiastic support of health reformers, who eagerly espoused the tenets of Republican motherhood. They understood that American mothers confronted new responsibilities in a reformed and reconstituted family, which they hoped would serve as the ideological model for social institutions and for society as a whole. Many of women’s new tasks fell under the rubrics of physiology, hygiene, and health. Women would be taught to practice domesticity as a science. Health reformers desired to elevate and professionalize the domestic sphere as a means of seeking an effective and practical role for women in a new and unpredictable social setting. “Now who,” asked a typical contributor to the Practical Educator and Journal of Health in 1847, “is the best qualified to supervise a household? She who has been thoroughly trained... or she who knows practically nothing about it.... Let woman be intellectually educated as highly as possible.”²⁵

The “cult of domesticity,” then, gave women new authority in the private sphere. The separation of home and work reduced the father’s role in domestic life while allowing increasing numbers of women to become primarily wives and mothers for the first time. At the same moment, changes in religious ideas enhanced the importance of parental nurture over predestination. The harsh doctrine of infant depravity bowed to a new belief in the malleability of young minds. Children and childhood were romanticized. The ideal of the modern family—small in size, emotionally intense, and woman supervised—made its appearance as a distinctive emblem of middle-class culture.

Many reformers noted these changes with satisfaction. In a letter to the Water-Cure Journal in 1854, the reformer Frances Dana Gage observed:

Because her procreative role often made a woman’s health more precarious than her mate’s, reformers devoted much attention to the state of female health. “If a plan for destroying female health, in all the ways in which it could be most effectively done, were drawn up,” announced Catharine Beecher in a discussion of what she judged to be middle-class women’s new idleness, “it would be exactly the course which is now pursued by a large portion of this nation, especially in the more wealthy classes.” Dr. James C. Jackson, founder of the Danville water cure, agreed. “American girls,” he lamented, “are all sickly.” “You are sick,” wrote Mrs. S. M. Estee to the feminine readers of the Water-Cure Journal, “and have been for months, years, and some of you your whole lives.”²⁷

We cannot know for sure whether or not this generation of women was sicker than their mothers and grandmothers. What is certain, however, is that they thought they were. Indeed, they well may have been. Fashionable dress took its toll on female health; the corset and tight lacing did much to damage female anatomy. Increased urbanization brought crowded and unsanitary living conditions. More and more middle-class women were denied the fresh air and exercise available to the rural housewife out of necessity rather than by choice. And the psychological strains of dislocation may have prompted some women to opt for ill-health, rather than stand and face changes which they could still barely comprehend. ²⁸

It soon became apparent to health reformers that only healthy, vigorous women could meet the challenges thrust upon them by a society in transition. Health reformers believed that woman was in the process of creating a new role for herself. “Woman ...” wrote Dr. James Jackson to his associate Dr. Harriet A. Judd, “is a new element in society just emerging from her hybernation ... and so much better fitted to take to herself new ideas, and develop them.” Good health was essential to woman’s new self-expression and improved status. “Let mothers be educated in all that concerns life and health....” insisted Mrs. Eliza de La Vergue, M.D. “Let them learn that knowledge gives the highest order of power.”²⁹

Good health became a prerequisite to woman’s new place in the world. “Woman was neither made a toy nor a slave, but a help-meet to man,” wrote “A Bloomer to Her Sisters,” “and as such devolves upon her very many important duties and obligations which cannot be met so long as she is the puny, sickly, aching, weakly, dying creature that we find her to be; and woman must, to a very considerable extent, redeem herself—she must throw off the shackles that have hitherto bound both body and mind, and rise into the newness of life.”³⁰

Women could achieve none of these goals until they learned to dress properly. Health reformers made dress reform a symbol of women’s new aspirations. Impractical clothes immobilized women and kept them from their responsibilities. Some regular physicians had linked fashionable dress to female ill health, but health reformers succeeded in making dress reform a moral imperative. Good health was doomed, they argued, as long as women clung to the dictates of French fashion. They called upon women to liberate their souls by freeing their bodies from the harmful effects of tight lacing and long, heavy unhygienic skirts. “How ... glorious,” mused Rachel Brooks Gleason, M.D., “would it be to see every woman free from every fetter that fashion has imposed! Such a day of ‘universal emancipation’ of the sex would be worthy of a celebration through all coming time.” Healthy bodies might even lead women into new arenas of accomplishment. “We can expect but small achievement from women,” warned Mary Gove Nichols, “so long as it is the labor of their lives to carry about their clothes.” “How in the name of common sense,” asked Edith Denner, “is a woman with long, full skirts, ever to become a practical Ornithologist, Geologist, or Botanist?”³¹

Health-reform journals pressed the issue. Lengthy technical descriptions of the damage wrought to female anatomy by the corset appeared, complete with diagrams. Pictures entitled the “Allopathic Lady, or Pure Cod Liver Oil Female, Who Patronizes a Fashionable Doctor, And Considers It Decidedly Vulgar to Enjoy Good Health,” were published side by side with those of women in reformed dress. A typical picture caption read “A Water-Cure Bloomer, Who Believes In The Equal Rights Of Men And Women To Help Themselves And Each Other, And Who Thinks It Respectable, If Not Genteel, To Be Well.” Not content merely to admonish their readers, some journals printed instructions for sewing bloomers. A modest sum could buy a pattern from the Laws of Life.³²

In a society where women were expected to play in increasingly complex role in the nurture of children and the organization of family life, health crusaders brought to the bewildered housewife, not just sympathy and compassion, but a structured regimen and way of life. In 1839 William A. Alcott took for granted the mother’s primary responsibility in child rearing and the father’s extended absence from the home. “All, or nearly all,” he wrote in his book The Young Mother, “must devolve on the mother. The father has not time to attend to his children.”³³

Burdened by this reorienting of their family responsibilities, many ordinary women found in the health-reform movement a means of coping with an imprecise, undependable, and often hostile environment. Lectures, journals, and domestic tracts provided friendly advice and companionship in an era characterized by weakening ties between relatives and neighbors. Women found a means to end their isolation and make contact with others of their sex. In study groups and through letters to the various journals, they shared their common experiences with other women. No longer must woman bear her burden alone. This collective sensitivity to the community among women was symbolized by the frequent references to “sisterhood” in health-reform literature.³⁴

“I wish,” wrote Mary Gove Nichols of her motives in becoming a health reformer, “to teach mothers how to cure their own diseases, and those of their children; and to increase health, purity, and happiness in the family and the home.”³⁵ For some women, Mrs. Nichols and her fellow reformers achieved these goals.³⁶ Numerous articles on cookery, bathing, teething, care of infants, childhood sexuality, cleanliness, and domestic economy carefully taught women how to manage their households properly. Itinerant physiological lecturers assaulted women’s widespread ignorance of their bodies. Nichols relied heavily on discussion of anatomy and physiology in her lectures. She instructed her listeners in the formation of bone structure, the role of respiration and circulation, the anatomy and physiology of the stomach. The process of digestion was described in detail. The remainder of her course involved information on dietetics and the importance of physical education. The alleged evils of “tight lacing,” and dire warnings against the harmful effects of masturbation—the “solitary vice”—also proved popular topics of discussion.³⁷

Advice on the supervision of pregnancy and childbirth was more “conservative” than that given by regular physicians and especially resisted the nascent definition of childbirth as a disease. Health reformers questioned this novel approach to the process of parturition, calling regular treatment “unnatural and often outrageous.” “Here,” observed Thomas Low Nichols,

“Under the popular medical orders of the day,” agreed Russell Trail, “pregnant females are regarded as invalids, and are bled, paregoric‘d, magnesia’d, stimulated, mineralized and poisoned, just as though they were going through a regular course of fever.” In contrast, health reformers viewed conception, gestation, and parturition as natural functions. They rejected the notion that pain in childbirth was inevitable, labeling such a belief “an insult to Providence.” They urged exercise, fresh air, proper diet, and cleanliness. Daily bathing was advised for infants, who were to be dressed in loose-fitting, comfortable garments to give plenty of opportunity for movement. No drugs were allowed for mother or child. Such attention to hygiene and diet probably improved the health of many, if we can believe the numerous testimonials from satisfied individuals to be found in the back pages of health-reform journals.³⁸

When the middle-class woman took possession of her life and the lives of those around her in the area of health, she sometimes gained the self-confidence to effect other changes within the family and in society. One doubts if this process was always conscious. But the psychological acceptance of various domestic responsibilities could lead often to subtle shifts in the power relationship between the sexes, giving rise to new attitudes toward what was and what was not acceptable in marriage. Nowhere was this process more apparent than in the health reformers’ attitudes toward sexual intercourse.

While some health reformers subscribed to the theory of female passionlessness, almost all were among the first nineteenth-century thinkers to prescribe restraint in sexual matters. Believing that good health required constant control, vigilant self-discipline, and vigorous dominion over man’s animal nature, they warned that of all the sensual passions, “the sexual element” was the most difficult to subdue. “No other element in our own nature,” wrote Henry C. Wright, “has so much to do in ... forming our character and shaping our destiny.... But what is done ... to bring the sexual element under the control of an enlightened reason and a tender conscience?”³⁹

Reformers clearly intended sexual restraint to benefit women and urged them to assert their rights in the sexual sphere. Much of female ill-health and infant mortality, they argued, could be attributed to husbands’ sexual abuse of their wives. Asserting that the male’s passion for copulation far outdistanced his wife’s, thinkers and educators urged men to follow the sexual rhythms of their more delicate spouses. ⁴⁰

Excessive childbearing allegedly endangered female health while it drained most women of the energy needed to perform the duties of educated motherhood. Hence, health reformers linked their insistence on sexual restraint to family limitation. They were among the first to advocate birth control publicly. Children, they argued, must never be the result “of chance, of mere reckless, selfish passion.” When, asked Henry C. Wright, “will men and women show a rational, conscientious, loving forethought, in giving existence to their children as they do in commerce, politics, and religion?” Every child should be a welcome child. “Welcome” became a code word for “planned.” The “great object” of sexual intercourse, continued Wright, was the “perpetuation and perfection of the race.” Couples not ready to have children should remain sexually continent⁴¹

In an era when many people were still largely ignorant of or opposed to artificial means of contraception, women benefited from such cautious attitudes in numerous ways. Historians have already documented many women’s profound fears of pregnancy in this period. Less frequent childbearing did improve female health. The desire to avoid conception probably colored women’s enjoyment of coitus. Some undoubtedly shared the common belief that failure to achieve orgasm would prevent pregnancy. Moreover, lovemaking techniques were often brutal and aggressive. Even nineteenth-century physicians, although aware of the female orgasm, knew very little else about the intricate nature of female sexual response. One suspects that middle-class women spoke to their husbands and sons of the laws of sexual continence with a degree of enthusiasm and a measure of self-defense.⁴²

While exalting the rewards of parenthood and elevating the motherly role, health reformers enjoined couples to limit the number of their offspring. The ideal of educated motherhood proved antithetical to large families. Women were simply incapable of achieving either the emotional intensity or the domestic expertise required of them when caring for a large brood. The injunction that parents should have fewer and better babies had its origins in the antebellum period, among these “enlightened” sections of the middle class.⁴³

Educated motherhood, with its approval of smaller families, preserved women’s importance while it emphasized their central role in the task of human betterment. Improvement of female health could lead to social regeneration. Woman was invested with awe-some responsibilities. “There are no duties on earth so nearly angelic as those which devolve upon women.” declared Alcott. “If all wives loved and delighted in their homes as Solomon would have them, few husbands would go down to a premature grave through the avenues of intemperance and lust, and their kindred vices.” The Lily, a feminist and temperance journal, emphasized woman’s moral power. “Woman’s influence is truly kingly in general society. It is powerful in a daughter and a sister; but it is the mother who weaves the garlands that flourish in eternity.” The gravity of woman’s influence went even beyond her own family, for health reformers shared a contemporary belief in the inheritance of acquired characteristics. “For the sake of the race,” explained Mary Gove Nichols, “I ask that all be done for woman that can be done, for it is an awful truth that fools are the mothers of fools.” James C. Jackson was even more blunt: “God punishes as well as rewards mankind through woman.... She is appointed to dispense divine retributions as well as divine blessings... through her does God visit the iniquities of the father on the children to the third and fourth generations.”⁴⁴

Though such attitudes gave women genuine responsibility and power, they also exacted a large measure of anxiety and even guilt. “Women are answerable, in a very large degree,” admonished Paulina Wright Davis, “for the imbecilities of disease, mental and bodily, and for the premature deaths prevailing throughout society—for the weakness, wretchedness, and shortness of life—and no remedy will be radical till reformation of life and practice obtains among our sex.”⁴⁵ Such a psychological burden might well have been unbearable had not health reformers given to women fellowship, moral support, and practical information.

By the end of the nineteenth century, reform ideas about personal cleanliness, public health, and family hygiene had become familiar axioms of middle-class American culture—a badge of distinction by which members could set themselves off from “illegitimate” immigrant groups, many of whom retained distinctly premodern daily habits and attitudes toward disease. ⁴⁶ Holding out to confused wives and mothers the prospect of improving the quality of life, not merely by changing the environment, but by gaining control of themselves, health reformers promised women that they could raise healthy children and keep husbands moral by cooking the right foods, and promoting exercise, cleanliness, and fresh air. The health-reform regimen established new standards by which middle-class women could measure their respectability and self-worth. Elevating the art of domesticity to a science, reformers restored to their followers a sense of purpose and direction, while, unwittingly perhaps, preserving in a new form traditional assumptions about woman’s role which were deeply imbedded in the culture⁴⁷

At the same time, the middle-class bias of the health reformers offered little support to working-class women. The cult of domesticity encouraged married women who had to work to aspire to an impossible goal—full-time motherhood—helping to make them undependable allies in labor disputes. Believing that their primary commitment should be to the family, they often accepted low pay and low status jobs, insisting that their situation was only temporary. The domestic ideology could also deepen women’s perceptions of class differences. Middle-class women were often advised to be cautious about the health of hired servants. Advice literature, for example, warned of the dangers of immigrant girls infecting the household.⁴⁸

Despite these drawbacks, health reform still represents an important chapter in the development of feminist domestic reform in America. Domestic feminism provided those women who were chafing under a too narrowly defined domesticity a practical approach to improving their status. Conservative domestic reformers such as Catharine Beecher concentrated primarily on “professionalizing” women’s traditional tasks in the home. More radical feminists like Caroline Dall, Paulina Wright Davis, and Elizabeth Blackwell attempted to construct out of the attention to preventive hygiene and physiological science a social ideology which chipped away at the edges of the public/private dichotomy that had emerged from the separation of home and work. These theorists found convincing justification for women’s public activity.⁴⁹ Although some historians draw a sharp distinction between domestic reformers and suffragists, suggesting that only the latter were truly radical and that domestic reformers “could aspire merely to modify women’s subordinate status, never to eliminate it,” such an approach obscures both the potential radicalism of many domestic feminists as well as the conservatism of a number of suffrage advocates.⁵⁰

Health reformers attracted both types of women to its ranks. For many it provided a means of moving into the public world without wandering too far from traditional womanly concerns. Yet though health reformers shared with conservative nineteenth-century Americans the belief that a woman’s role was invested with cosmic moral significance, they subscribed to the widest possible definitions of woman’s sphere. They understood that to purify society some women might indeed have to enter it. For bolder thinkers in the antebellum period, the movement’s protective shelter sanctioned not only the exploration of professional roles for women, but the search for a radical alteration in the relationship between the sexes.

Health reformers did not welcome the changing social and economic patterns which seemed to accentuate the separation between men and women, and they often longed in their rhetoric for a lost age of harmony.⁵¹ As members of a small group among the middle class who were in many respects social innovators, they benefited early from the increase in leisure and the spread of education to women which resulted in more uniform attitudes toward the socialization of the sexes. These developments worked to narrow the gap between men’s and women’s experience, even as work patterns between the sexes became more sharply distinct. Thus, they preached a degree of male-female mutuality and companionship which spoke to their own experience as reformers but did not take hold among larger segments of the population until well into the twentieth century.

Openly rejecting traditional authoritarian concepts of marriage, they favored a relationship based on mutual love, common interest, and affection. Men were urged to pattern themselves after their wives, while women were told to imitate the strength and conviction of their husbands. Groping toward a redefinition of masculinity and femininity, James C. Jackson, the founder of the Danville Water Cure, observed,

Fathers were urged to forsake the pursuit of money and re-involve themselves in the wholesome atmosphere of family life; the spiritual rewards of parenthood were emphasized. Married couples should learn to share each other’s concerns. Indeed, the pursuit of a “companionate marriage” led many young men and women to advertise for like-minded mates in the Water-Cure Journal, which for a number of years devoted an entire section to matrimonial advertising. One such ad, placed by “Henry Homes” paints an inviting scene of the mutuality inherent in the reformers’ ideal of domestic life:

Women advertised as well. “I am thirty years old,” wrote “Victoria,”

Of course, they never claimed that men and women were the same. Their vision of companionate marriage, in typical nineteenth-century fashion, depended on their high valuation of women’s moral superiority. Women were indeed different from men, and their special abilities were much too important to confine to a narrow sphere. Thus, only a short step from their assessment of women’s natural abilities in matters of health lay the argument that women should study medicine.

Indeed, the entrance of women into the medical profession received powerful stimulus from the health-reform movement. “In sickness there is no hand like a woman’s hand,” the Water-Cure Journal reminded its readers. “The property of her nature,” argued a contributor to Godey’s Lady’s Book, “which renders her the best of nurses, with proper instruction, equally qualifies her to be the best of physicians. Above all is this the case with her own sex and her children.” Enthusiastically, health reformers applauded the early acceptance of women as medical students at sectarian institutions, chiding the regulars for their conservatism. “What,” asked the editor of the Water-Cure Journal, “will our Allopathic doctors say to this? We pause for a reply. In the meantime, our women are buckling on the armor for a struggle which must ultimately prove successful.”⁵⁴

Women interested in health reform and medical study did not, however, confine themselves only to sectarian medical institutions. Ann Preston herself gave physiological lectures for many years after she received her degree. So, too, did Drs. Hannah Longshore and Angenette Hunt, two of Preston’s classmates from the Woman’s Medical College of Pennsylvania. Samantha Nivison, who received her degree there in 1855, went on to found a water-cure institute near Ithaca, New York—not far, as a matter of fact, from a similar establishment owned by Dr. Cordelia Greene, who graduated from Western Reserve Medical School in the same year that Nivison finished in Philadelphia. Clemence Lozier, on the other hand, began her health-reform career as a teacher and lecturer before she entered the Eclectic Medical College of Syracuse for a medical degree. Finding homeopathy the most congenial of all the medical persuasions, she established the New York Medical College and Hospital for Women in 1863. Lozier eventually became an active figure in New York reform circles, where she maintained a long and intimate relationship with Elizabeth Cady Stanton. Mary Gove Nichols also founded a medical school in New York—The Hygeio-Therapeutic Institute—after a decade-long career as a health reformer. Indeed, the close relationship between feminists, health reformers, and pioneer women physicians clearly illustrates their common goals. In time these early women physicians, who were attracted to medicine out of an ardent desire to fulfill their destinies as superior moral beings with natural abilities to cure, would be transformed into full-fledged professionals by their contact with an increasingly scientific and empirical discipline. They, as well as their system of values, would be permanently altered in the process.