Narratives of Class, Gender and Medicine in the American South: The Dr. Annie Alexander Story
1 Dr. Annie Lowrie Alexander (1864-1929) of Charlotte, North Carolina, is credited with being the first woman graduate of a medical college to practice in the American South. Although the truth of this statement is difficult to ascertain, Alexander was certainly acutely aware of her novelty and her status as a role model for young women. Over time, she was an outstanding success both as a practitioner and a businesswoman in the New South. Born into the eminent Alexander family of plantation stock in Mecklenburg County, North Carolina, the quiet grace, modesty, and “Southern womanhood” of “Doctor Annie” were frequently noted by male contemporaries. The United Daughters of the Confederacy turned out en masse for her funeral. At the same time, Alexander was an advocate for medical reform in the Progressive Era South, especially in relation to the health of women and children. Her endeavors for systemic reform found expression in campaigns for compulsory medical inspection of school children and co-operative rural public health nursing. Equally important to her as a health reformer was moral improvement, within families and especially among adolescent women. The story of Dr. Annie Alexander’s career in Charlotte, 1887-1929, as a general practitioner specializing in the diseases of women and children is an important one to analyze. There exists, moreover, a second story, this one a work of fiction. Alexander composed the short story “Doctor Katherine” early in her professional career, possibly in the winter of 1886-87, following her graduation from the Woman’s Medical College of Pennsylvania in 1884, internship, and licensing. The protagonist is a young southern white woman who made the unheard of career choice of medicine, attended the Woman’s Medical College, Philadelphia, and overcame prejudice and private doubts to establish a practice in a southern city not unlike Charlotte. Alexander bestowed upon her fictional character the name of Dr. Katherine Caldwell. Alexander’s paternal grandmother was a Caldwell, a family illustrious in North Carolina’s Revolutionary War history and the grounds for Alexander’s later cherished role as a Daughter of the American Revolution. The autobiographical features of “Doctor Katherine” extended beyond curly fair hair and blue eyes, to the fact that the author and her subject each possessed a physician father who directed his daughter towards a career in medicine. The principal importance of “Doctor Katherine,” however, lies not in autobiography; rather, it was Alexander’s first known effort to interest southern adolescents, of her race, class, and gender, in medicine. As such, it will be examined alongside Alexander’s non-fictional work in this field. This study, therefore, possesses three overlapping objectives. One is an examination of Annie Alexander’s career as a single, white, elite woman in medicine, with an emphasis upon how she saw, and acted upon, the intersections of gender, class, and race. Another is to permit Alexander to speak to us in her fictional character of “Doctor Katherine.” The final theme is the investigation of Alexander’s views on women in medicine, in health, and in life; these were rooted in her time, place, and person. [1]The author is pleased to acknowledge the assistance provided for this study by the Special Collections Department, Atkins Library, University of North Carolina at Charlotte, in particular for a Harry Golden Visiting Scholar Award for 2008/09 to study the Dr. Annie Lowrie Alexander and Dr. John Brevard Alexander collections. A travel grant from the Institute for Southern Studies, University of South Carolina, 2006, was instrumental for situating Dr. Annie Alexander within her medical world of the Carolinas.
Doctor Annie Alexander
2 Annie Alexander was born on 10 January 1864 in Lemley Township, Mecklenburg County, on the farm of her father, Dr. John Brevard Alexander (1834-1911). She died twenty miles away on 15 October 1929 in the bedroom of the home and medical office which she purchased in 1890, 410 North Tryon Street, Charlotte, Mecklenburg County. Her father graduated from the Medical College of South Carolina in 1855; he served in the Thirty-seventh North Carolina Infantry as a private, 1861-62, and as surgeon, 1862-65. Her mother, Ann Wall (nee Lowrie) Alexander (1834-93) was a granddaughter of North Carolina Superior Court Judge Samuel Lowrie (Dudley 13; Murphy 15). Alexander moved her parents into her Charlotte home in 1890. John Alexander was a druggist and general practitioner until his health deteriorated in 1898. He published extensively on local history and genealogy, public affairs, and religion. He was an unapologetic Confederate and a strident racist (History 370-82; Reminiscences 109-12, 237-39).[2]John Alexander, “Insane Negros,” “The High Order of the Human Race not Maintained,” and “Sin Has so Corrupted Our Natures” (undated essays), and “The Mixing of Races Should Be Condemned” (1886): John Alexander Papers, Box 1, Folders 13 and 15. Alexander was home-schooled by her father and a tutor. Family tradition credits her father with the choice of medicine for his second daughter; in 1881 he secured for her a place at the Women’s Medical College of Pennsylvania (Pendleton 43; Thompson 14).[3]Annie Alexander (hereafter “Alexander”) to John Alexander, 2 Jan. 1884: Alexander Papers, Box 1, Folder 1. College entrance exams were not introduced until 1887 (Marshall 69). The surviving letters between Annie and her parents during her residence in Philadelphia reveal a close bond with her father, centered around their mutual interests in medicine, and a distant connection to her mother.[4]Alexander Papers, Box 1, Folder 1. Alexander secured a second-class graduation result in spring 1884, but was one of the favored few awarded a coveted internship at the Woman’s Hospital of Philadelphia, 1884-85.[5]Woman’s Medical College of Pennsylvania (hereafter WMC) Archives, Minutes of Faculty Meetings, 1881-86 (unpaginated), entries for 7 Feb. and 8 Mar. 1884; WMC 1882, 20; WMC 1884, 4; WMC 1885. During this year, she announced her intentions to practice medicine in the South, determining that only in a large, cosmopolitan city could she be reasonably certain of acceptance and a livelihood. She wrote in summer 1884: “I can’t decide where to locate when I leave Philadelphia. I’ve thought of Baltimore, Atlanta, and Jacksonville, but there will be obstacles wherever I locate. My success will depend on my ability and the liberal views of the people among whom I will be.” In the end, the choice was Baltimore.[6]Alexander Papers, Box 1, Folder 1.
3 In 1885 Alexander accepted a poorly paid position as assistant instructor of anatomy at the Woman’s Medical College, Baltimore, sat the Maryland licensing examination, and opened a private practice. John Alexander had provided his daughter with financial support since 1881 and this continued.[7]Alexander Papers, Box 1, Folder 1: Alexander to John Alexander, 8 June 1886; WMC, Alumnae “Firsts” file card; Dudley 13. Alexander’s career took a sudden turn in summer 1886. Severe pneumonia and weight loss were followed by tuberculosis; the winter of 1886-87 was spent recovering at a relative’s Florida home (cf. Pendleton 62-63).[8]Alexander Papers, Box 1, Folder 1. In the spring of 1887 the following advertisement appeared in the Charlotte Observer: “A nice young female physician, Miss Annie Lowrie Alexander, has located in this city ready to practice among women and children and consult about female disorders generally […]. She has been educated in the best medical schools of the country” (qtd. in Kratt 12). The novice general practitioner boarded with a Mrs. Harvey Wilson and shared office space with one Mrs. Lathan (not a medical practitioner) in downtown Charlotte opposite the post office. Alexander was in the one southern city she had determined in January 1885 to avoid at all costs: “Charlotte, [because] the people there have more curiosity then sincerity and politeness.”[9]Alexander Papers, Box 1, Folder 1, Alexander to John Alexander, 11 Jan. 1885. She was the first licensed woman physician in North Carolina’s history; over time Alexander came to relish that role, and to contribute to the developing story that she was the first in the south-east United States or, indeed, in the South.[10]Alexander’s own role is suggested by the family narratives recorded by Pendleton and Thompson, and supported by the surviving fragments of an undated autobiographical description of herself (in the third person): Alexander Papers, Box 1, Folder 5. All accounts of Alexander, from her death to the present, emphasize that she was “the first,” but the geographic scope ranges from the state of North Carolina to the entire South, and many accounts neglect to add the important qualities of “graduate physician,” “licensed,” and “southern born.” In the standard biography (by Dudley) it is, for example, demonstrably not true that Alexander upon her return to North Carolina in 1887 “became the first woman to practice medicine in the South.” She had been preceded by numerous non-graduate and/or unlicensed practitioners, as well as by several graduate, licensed women physicians who had not been born in the South.
4 There appears to be no truth to the family story that Alexander struggled for her entire first year in private practice before earning her first dollar, such was the prejudice in Charlotte against a woman in medicine (Pendleton 63; Kratt 12). The first of her surviving patient casebooks covers the period January 1888 to November 1889. For the calendar year 1888, Alexander recorded 432 patient consultations, for an income of $684.00. She did $31.50 worth of charity work.[11]Alexander Papers, Box 1, Folder 13, patient casebook, 1888-89. This volume references, and has patient illnesses carried over from, an earlier volume for 1887 (not now extant). The evidence suggests that Alexander took whatever clientele she could. This is the only one of the extant casebooks where there are any significant number of adult male patients, or African-American women, albeit even at this stage in her career both were distinctly in the minority. Most of her case work was gynecological, but included as well bilious fever, consumption, the common cold, indigestion, carbuncle, debility, and a sizeable practice in neurology. By the time of her next surviving casebooks, 1914-22 and 1924-29,[12]Alexander Papers, Box 1, Folders 14 (1914-22) and 15 (1924-29). Alexander was a very well established Charlotte professional, in practice at the two city hospitals, and physician to the Young Women’s Christian Association, the Presbyterian College for Women, and the Florence Crittendon Home for unwed mothers.[13]Alexander Papers, Box 1, Folder 11 (newspaper clippings), “Pay Tribute to Dr. Alexander,” 15 Oct. 1929, “Funeral to Be Held Today for Dr. Alexander,” <em>Charlotte Observer</em>, 16 Oct. 1929. Her general practice between 1914 and 1929 was almost entirely in gynecology, obstetrics, and childhood diseases. Apart from immediate family, adult males had disappeared, and African-Americans were virtually non-existent. Alexander practiced throughout Charlotte, rural Mecklenburg County, and nearby South Carolina communities. Social class is harder to establish, for the physician rarely included signifiers. However, cross-referencing names and addresses from the casebooks with city directories establishes that Alexander’s patients ran the range from the most prestigious families to the wife of the city’s garbage collector. Her practice was weighted towards those who could afford her fees. For example, a large number of women, often recently married, appeared in the records only once, for a pregnancy examination and determination. Their health needs, and deliveries, were being met elsewhere. Alexander charged $2.50 for this exam, and $25.00 for delivery and post-natal care; her standard fee for a consultation was $2.00.[14]Alexander casebooks, 1914-22, 1924-29. Overall, the practice may be described as overwhelmingly white, with a preponderance of women from the elites and the middling layers of local society – nurses, school teachers, the wives of accountants, and the like. It is difficult to locate in her records the families of mill hands or tenant farmers, of either race. These women and children may be present, but certainly not in sizable numbers; their existence and growth, however, was a striking feature of the new industrial Charlotte and its immediate hinterland.
5 Charlotte underwent rapid social and economic change in the 1887-1929 period. When Ann Lowrie married John Alexander in 1858, the city was a modest local agricultural community of slightly more than 1,000 people. By the time of Annie Alexander’s death in 1929, the population stood at 82,000, surpassing every urban center in North and South Carolina. Charlotte was the nexus of four major railroad systems, and the heart of a textile manufacturing territory in the Carolinas’ Piedmont of 770 mills (Hanchett 19-20, 90-92; Alexander, History 382; Blythe and Brockman 138). As early as 1896, Mecklenburg County was the third most important textile manufacturing county in the state; within a decade city boosters proclaimed that “[o]ne half of all the looms and spindles of the South are within one hundred miles of this city” (D. A. Tompkins qtd. in Hanchett 92). This was “an onward-driving, pulsating South in industry, agriculture and finances. […] Charlotte is alive, aggressive, progressive. Charlotte citizens cooperate in matters which promote the civic, commercial, religious, and industrial welfare of the community” (Hill Directory Company 11-15). This marketing message failed to mention Mecklenburg County’s long history of bitter industrial strife, or the serious social and public health problems which had grown alongside the population (Hanchett 18-104). Moreover, the declaration that Charlotte’s labor was the finest in the country for prospective employers, “native, white, sober, industrious,” ignored both the strikes and the presence of 28,936 African-Americans, 35% of the city’s population (Hill Directory Company 11, 16). Thus, in the period circa 1890-1930, Charlotte emerged as a large, progressive center in the New South, prominent in finance, housing construction, and the service industries, in addition to transportation, agriculture, and textiles. At the same time, it was necessarily ridden with racial and class divisions, and serious contestation over all aspects of social welfare, from education to health (cf. Hanchett).[15]The relationships between the public health challenges and the economic transformation of Charlotte and its hinterland have not been the object of extensive scholarship, but can be traced in the surviving records of the Mecklenburg Country Health Department, the North Carolina State Board of Health, and the biannual published reports of the latter body.