Literature and Medicine I

6 Annie Alexander, the scion of the old country plantation aristocracy, embraced the new progressive Charlotte. Her education and professional stature placed her firmly within the urban elite, while her extensive investments first in rental housing and then in textile mills aligned her with the new economic order. Alexander’s career was marked by professional and financial success. These topics had been her expressed anxieties while interning in Philadelphia: could she acquire professional recognition and a livelihood in medicine.[16]Alexander Papers, Box 1, Folder 1, letters to John Alexander dated Jan.2, June 30, Nov. 9, 23, 1884, Jan. 11, 18, Feb. 25, 1885. It is reasonable to conclude that she was successful because she was in a good place at a time of opportunity, and because she worked very hard to achieve her goals. Alexander’s first publication, in January 1889, was of an address which she had recently delivered at a women’s college in Greensboro, North Carolina, on the theme of “Women Physicians” (discussed below). In March of the same year she contributed a paper on chronic inflammation of the lining of the uterus to her College alumnae association in Philadelphia (“Chronic Corporeal Endometritis”).[17]The paper was read and discussed in her absence. In 1894 she published on “Uterus, Hyperplasia of” in the Charlotte Medical Journal, and in 1897 on “Menstrual Disorders” in both that periodical and in the North Carolina Medical Journal (cf. Marshall 101).[18]WMC, Alumnae card file. Upon the establishment of the Mecklenburg County Medical Society in 1903, Alexander was a frequent speaker at meetings, drawing upon her practice. She served as the founding first vice-president of this Society, 1903-05, and as its president in 1909-10, the period of the Society’s first hookworm campaign (Strong 58, 62). In 1924 Alexander served as first vice-president of the Women Physicians of the Southern Medical Association.[19]Alexander Papers, Box 1, Folder 3. She was a frequent speaker on medical themes, mostly to audiences in North Carolina. When venturing further afield, for example in one presentation to the Charleston Medical Society on calcareous deposits in a young woman patient, Alexander was exceptionally cautious, providing only the medical facts, offering no analysis, and denying that the case was significant.[20]Alexander Papers, Box 1, Folder 3. A slightly altered version, in her handwriting, was copied into blank pages of her father’s last casebook, with the title “Calcareous Deposits in the Lungs”: John Alexander Papers, Box 1, Folder 7 (unpaginated). All the manuscript essays by Alexander cited below are in her handwriting. Many lack exact titles. Unless stated, the essays are undated, but internal evidence, or case descriptions in her casebooks, often permit approximate dating. Her research included “Management of the Puerperinum,” “Cervical Adenitis,” “Symptoms of Lobar Pneumonia,” “The Care of the Premature Infant” (1914), as well as “Summer Complaint” (1893), and “Pneumonia” (1896). Her last known research contribution was on three cases of “Tuluremia” (1928, 1929), a serious infection transferred from live rabbits and present in 29 American states.[21]Alexander Papers, Box 1, Folder 3. As early as 1896 Susie Van Landingham, the acknowledged matron of Charlotte’s social elite and wife of the city’s leading cotton broker, paid Alexander a public tribute: “She has won for herself […] an honored place among the [medical] fraternity and a practice that is both lucrative and successful” (qtd. in Henderson-Smathers 41).[22]For Van Landingham’s role in Charlotte cf. Kratt 20-22. Upon her death in October 1929, the Mecklenburg County Medical Society acknowledged Alexander as one of its most enthusiastic, highly honored, and respected members.[23]Alexander Papers, Box 1, Folder 11, “Death of Dr. Alexander Subject of Resolutions” (undated newspaper clipping of Oct. 1929).

7 Alexander was a competent and successful business woman. She was frugal in her personal expenditure; after the deaths of her parents she even took a lodger into her home. Beginning with the down payment on her own house and office in 1890, she bought real estate, owning at various times as many as twenty rental houses and commercial offices in Charlotte, all of which she managed herself. In 1921, Alexander’s total revenue was $4,868, and expenditure $2,570, for a profit of $2,298 (up from $1,492 in 1920).[24]This, and the following, information has been extracted or calculated from Alexander’s personal financial records, 1920-29: Alexander Papers, Box 1, Folders 7, 8. Apart from some financial information included within her patient casebooks, these are her only financial records to survive. They reveal a very careful attention to detail, especially for expenditure. Her medical practice had brought in $1,923.10; her rental properties yielded $2,222.89. As was always the case, she invested all profits. In 1922, total receipts were $4,830, expenses $2,500, and profit $2,330. For this year, the practice had brought in $1,622.10, and rental properties $2,379.54. In 1923 her practice provided $2,047.85 and rental properties $2,408.25, with a net profit for the year of $3,096.51. Additionally, Alexander was now steadily selling off her rental properties (in 1923 she acquired a further $5,741 from these sales) and re-investing in local textile mill stocks. In a speech intended to interest young women in a career in medicine, Alexander stated that the total costs of four years at the Women’s Medical College, Philadelphia, would be approximately $1,900 to $2,300, covering all tuition, board, books, and incidentals. Upon graduation a teaching or laboratory position would immediately bring in a good income of between $1,000 and $4,000 a year. The financial returns from private practice would be slower to materialize, and the extreme range was from $400 a year to $10,000. One woman physician known to Alexander was said to earn $20,000.[25]Alexander, “Woman [sic] in the Medical Profession” (circa 1920), Alexander Papers, Box 1, Folder 5. As a self-employed physician, Alexander wrote off on her income tax submissions the entire upkeep on her automobile, her telephone, depreciation on her rental properties, and part of her house expenses. Although any comparison is inexact, in 1927 the annual salary of the full-time Assistant Health Officer for Charlotte and Mecklenburg County was $2,400; the prestigious part-time position of County Physician paid $1,200.[26]Mecklenburg County Health Department Archives, Box 1, Folder 7, Minute Book, 1915-55, 3, 22-24, 47. It appears from Alexander’s financial and medical records for the 1920s, that she was acquiring capital largely through careful attention to expenditure and making wise investment decisions, rather than attempting to maximize the work of her general practice. This afforded her considerable leisure for civic involvement.

8 In addition to her private practice, Alexander was active in medicine and public health within her community. Her actions in this arena are often shadowy. For example, the obituaries emphasize Alexander’s importance for the creation and performance of the Charlotte Co-operative Nursing Association; however, there is nothing on her work itself in either the Alexander papers or the records of the Mecklenburg County Health Department. Too frequently, we know that she held a position of responsibility, as a trustee or board member, without being able to assess her involvement. Alexander was largely responsible for the health education program of the Charlotte Women’s Club, and she was instrumental in establishing through that body the local sale of tuberculosis seals (cf. Henderson-Smathers 41).[27]Charlotte Woman’s Club Archives, Box 1, Folder 1 (notices of Alexander’s activites, 1900-1926); Henderson-Smathers 41. She actively promoted the compulsory medical inspection of school children. In November 1917 this led to her wartime appointment as medical director of Charlotte’s public schools, paid by the United States Public Health Service, with the standard (usually male) federal title of “acting assistant surgeon”, and working alongside the city health department. The objective was to maintain a high level of health within the five-mile sanitary zone surrounding the army’s Camp Greene. Alexander and the health department were able to use this concern in order to accomplish unprecedented health work in Charlotte’s schools, including the medical inspection of thousands of children.[28]Alexander Papers, Box 1, Folder 11 (newspaper clippings, 1917-18); Mecklenburg County Health Department Archives, Box 1, Folder 7, Minute Book, 1915-55, 3; Charlotte City Board of Education Records, Box 1, Folder 7; North Carolina State Board of Health 1921, 17, 22, 26, 40-45, 47, 49-52; Alexander, “Medical Inspection of Schools,” and a briefer, untitled, essay by her on the same topic (Alexander Papers, Box 1, Folder 2). Public health, however, was never at the center of Alexander’s career. She routinely devoted more attention to non-medical charitable activities than to the ones identified above. It is undoubtedly true that Alexander herself would have approved of the summation of her adult life in Charlotte, provided in the obituary news report of the Charlotte Observer: “she was recognized as a leader in the civic, social and business life of this city.”[29]Alexander Papers, Box 1, Folder 11, “Last Rites for Dr. Alexander Held Today,” Oct. 16, 1929. A fair summary of her adult life is that these were her personal objectives, and through dedication and talent she accomplished them.

Commentary on “Doctor Katherine”

9 This short story evidently was intended for publication, presumably in a magazine with a readership of adolescent women. One fair copy, with several stylistic alterations, exists among Alexander’s papers, in her handwriting. In the top right margin of the first page, Alexander has added, “Miss E. Goheen 2301 Master St. Phil. Pa.”[30]Alexander Papers, Box 1, Folder 6. Elizabeth Henri Goheen, of the Philadelphia suburb of Media, was a student at the Woman’s Medical College of Pennsylvania, 1892-96.[31]WMC, Alumnae card file, and Minutes of Faculty Meetings, entries for May 1894, Feb. 1895, May 1895. It appears that Alexander’s intention was to send the story to Goheen. Whether it was dispatched and returned, or never sent, is not known. The paper is not listed among Alexander’s publications in the records maintained by the Woman’s Medical College (cf. Marshall 101).[32]WMC, Alumnae card file. As far as can be ascertained, it does not appear to have been published. The purpose of the story appears to be straightforward: to provide a positive example of a woman’s career choice in medicine suitable for young readers.

10 The manuscript is undated. The story was written early in Alexander’s professional career, after her education but before she became well established upon her career path in Charlotte. The Goheen notation implies that the manuscript was created after she left Philadelphia in 1885 and before Goheen left the College, without a degree, in early 1896. The narrative has Dr. Katherine establishing her practice within her home community in the South, not in a large city such as Baltimore (where Alexander began her career, 1885-86). “Doctor Katherine” may well have been composed during a period of reflection as she convalesced in Florida over the winter of 1886-87, or early in her efforts to establish a practice in Charlotte. It may be noted that the character Mary Berry gave Dr. Katherine Caldwell’s age as twenty-two when Caldwell returned to her state. Alexander was this age at the time of her health crisis. It may also be relevant that the only letters from a “male admirer” retained by Alexander in her papers were from the winter of 1888-89. This unidentified male appeared to be a physician, and he proposed marriage.[33]Alexander Papers, Box 1, Folder 1 (the signature is unreadable).

“Doctor Katherine” by Annie Alexander

It was the day before commencement at Parkhurst Academy. Several members of the graduating class were assembled in the grounds in front of the building talking of the future before them. “I am going to be a teacher,” said one. “I am going to be an artist,” said another. “And I a professor of languages,” said Mary Barry. “I shall marry,” said Nettie Bell. “What are you going to do Katherine?” asked Mary Barry. “Study medicine.” “Study medicine! Be a doctor! Who ever heard of such a thing!” “Are you in earnest or romancing?” asked Mary. “Yes, I am going to be a doctor. It has been father’s desire all my life, that I should be a physician.”[34]The family story for Alexander is identical (cf. Pendleton 42, 62; Thompson 14). “Your father must be a mad-man to allow such a thing or to consider it for a moment,” said Nettie Bell. The idea of a daughter in a Southern family doing anything outside of home or the schoolroom was unheard of. And to bring the idea closer home, for Katherine Caldwell the fetted daughter of Dr. and Mrs. Caldwell to study medicine was shocking. Katherine Caldwell was the second daughter in a large family of children.[35]Alexander was the second (of three) daughters, with five siblings in total. She was shy and diffident toward strangers, gentle and quiet in manner, and was possessed of that excellent thing in woman, a voice soft and low. Her light wavy hair, coiled loosely at the back was her one crown of beauty. From her blue eyes shone her steadfast earnest soul.[36]For Alexander’s curly golden hair and blue eyes cf. Pendleton 42, 62. “Yes, I am going to be a doctor. If you have recovered from your shock I’ll tell you about it.” Katherine’s quiet serious face showed that she was not as brave at heart about going to Philadelphia as she would have her friends believe. The girls listened with interest as she told them of hers and her father’s plans for her to enter The Woman’s Medical College of Pennsylvania in Philadelphia in October. “Of course I shall only practice among women and children.” “That is not fair,” said Will Herndon,[37]The names “Will” and “Will Herndon” appear throughout the manuscript on top of an erased name. who had stopped a moment in passing. “All the boys will want you to visit them.” Will was just home from the University of Virginia where he had been studying medicine. “She could not prescribe for you Will, your pulse would go bounding away at such a rate and you would begin stammering at her first question,” said Jennie Strong. “You see Will, it would never do,” said “Dr. Katherine” as her friends begun calling her. “I could never make a diagnosis with such varying symptoms as you would present.” “Diagnosis, symptoms! My! How doctory she sounds,” said Jennie. Will turned and walked on with regret in his strong noble face. “Doctor [struck out: Margaret Winters] Mary Walker [inserted] is the only woman doctor I ever heard of,” said one of the girls, “and she has short hair and dresses like a man.” “Not exactly like a man,” corrected Katherine. “And there are a great many woman physicians throughout the north and west, who are just as loveable and womanly as the women in our Southern homes whom our men love to honor.” “I can’t conceive of a doctor wearing skirts and feathers,” said brown eyed Nettie Bell, who thought more of her beau than her books. “I would have no confidence in a woman as a doctor,” said candid Jane Smith. “Why not Jane?” asked Katherine. “Why because women haven’t the brain power necessary to make good doctors, and they are too nervous and scarry [sic].” “Doubtless you speak from an intimate acquaintance with yourself Jane,” said Mary Barry. “If you will take the trouble to make inquiries, you will find in schools where co-education exists that the women are not behind the men. In many instances they lead the classes. As for being nervous and scarry [sic], did Katherine appear so when little Ned fell from the tree and broke his arm so badly? No, Doctor McLean said she had set it as well as he or any other doctor could have done.”

* * * * * * * * *

Six months later Katherine Caldwell is in Philadelphia attending lectures at the Woman’s Medical College. The first lecture she heard was on “Protoplasm”. After listening to the lecture one hour she turned and asked the student behind her, “What is Protoplasm?” What a trial those first six weeks were! Loneliness, and homesickness and tears. She attended the lectures and studied the dictionary. Everything was chaotic. After a while things became clearer and a keen interest took the place of the homesickness. A new world was revealed to her. Sickness and suffering such as she never suspected aroused her deepest interest and sympathy.[38]The first lecture of the autumn 1881 term at the Woman’s Medical College was on 6 October, on gynecology: WMC, Minutes of Faculty Meetings, 1881-86. This was the first year that the College required student attendance at both a winter and a spring term of lectures. The chair in gynecology has been established in 1880. The Clinic Hall (referenced by Alexander below) was constructed in 1883. Cf. Marshall 69, 82-83. Alexander’s papers contain her notebook on academic and clinical lectures attended at the College, 1881-83 (Box 1, Folder 12). Most date from her second year and suggest a competent, informed student. The first clinical lecture attended by Alexander in 1881 was of a baby with skin eruptions; the second was for a blister on a woman’s ring finger. Katherine’s greatest trial was the dissecting room. How the shivers ran up and down her spine as she heard the elevator rumbling up from the basement to the top story! One of the advanced students said, “There goes a subject to the dissecting room, let’s go up there.” “A no,” said Katherine, “dry bones are a great deal more interesting just now.” They were studying the skeleton then. “Oh she is chicken hearted. Let’s go. You may stay Miss Caldwell.” “Oh I don’t mind it,” said Katherine faintly, “I’ll go of course.” The sight that greeted her eyes was appalling. Several long marble tables, on each lay a subject carefully covered, but the human outlines were visible. It was horrible. It was the first time she had seen death. She walked over to the window and stood for a few minutes looking over into Girard College grounds, until she could get her nerves under control. By degrees she brought herself to look upon the ‘subjects’. How cruel and wicked it all seemed! Once these poor bodies were a joy and comfort to someone’s heart. But now – now – it was too much for her. She quietly left the room unnoticed. The worst part was to come. Later in the winter Katherine was assigned a part to dissect. It was awful. It seemed impossible for her to make the first cut. But after it was begun her horror and disgust were gradually absorbed by her interest in the wonderful and beautiful arrangement of muscle, nerve, vein and artery. Her first year at college quickly passed with lectures, clinics and laboratory work. The clinics at the Pennsylvania and Blockly Hospitals were open to the Woman’s College students where they were not always well received by the Jefferson and University students.[39]Alexander was subsequently to write on the infamous challenge by these males to women students of the Woman’s Medical College in the autumn term of 1869 with such passion, that some biographies have mistakenly believed she experienced the identical events. Alexander, “Woman in the Medical Profession”: Alexander Papers, Box 1, Folder 5. For 1869 (cf. Peitzman 34-38). One day a little missionary student from Virginia fainted. She felt it coming on and felt certain that if she did it would afford great fun to the Jefferson students present. Just as soon as possible she raised up off the seat where friends laid her. The only notice taken of her was: “Don’t set her up too soon, it’s often the cause of death,” and without a pause the Professor went on with his clinic, presenting the symptoms and treatment of a typhoid fever patient before him.

* * * * * * * * *

Katherine is home for the vacation after two winters in Philadelphia. How she enjoys every hour! How beautiful seem the grass and trees and birds and soft springy earth, after a winter in Philadelphia where hard pavements, brick walls and English sparrows abound. Katherine looks just as she did two years ago. Some I told-you-so people are disappointed to find she has not put on bloomers. Her gentlemen friends have been slow in calling, fearing to find her changed from a gentle girl into a masculine woman. One evening a few days before her going to college for the last year, a party of young people called to bid her ‘Good bye.’ The evening passed all too quickly. It seemed like old times before Katherine went to College. The last good bys were said, but Will Herndon lingered. “Good by Katherine. I don’t suppose I will ever see you again,” said Will dolefully. “What’s the matter,” said Katherine, “you’re not ill? Don’t feel like dying do you? Let me feel your pulse.” “I’d rather you would listen to my heart,” said Will with a poor attempt to smile. “Katherine, will nothing induce you to give up this mad idea of ruining your life?” “If you call a noble useful life, which a woman doctor’s life is, a ruined life, mine will be ruined. I have seen the necessity for women physicians and you must have seen the same in your college and hospital work.” “It seems well enough for others to study and practice medicine but for you –. I wish I could persuade you that your happiness lies in another place. Katherine –.” “Will it is useless,” said Katherine quickly. “There is a niche for each of us and I must fill mine.” “Katherine, don’t tell me you will never marry. Some day you will [struck out: love and marry] but no man will love you better nor strive harder to make you happy than I would. The happiest lives are married lives.” “That may be true Will. Being an old maid I may miss a few joys but I shall escape many sorrows.” “I am going to open an office and begin work in Peoria soon,” said Will. “I had a letter from Tom Willets the other day telling me there was a good opening there for an active young physician. I will bury myself in my books and journals till work comes. How I shall long for work, hard work to try to forget the happiness I have missed.” “Good by Katherine,” a pressure of her hand and he was gone. Katherine sat gazing into the heavens through her open window. She neither saw the stars nor the silver crescent that hung in the west. She saw Will’s earnest pleading face. She thought of the happiness she might have had as his wife and wondered if the happiness would compensate for all the suffering and sorrow and heartache and tears that might come with it. Her heart answered “yes”; her head said “no.”

* * * * * * * * *

The three College years have ended and Dr. Katherine Caldwell is the proud possessor of a diploma entitling her to practice the science of medicine. After having spent a year profitably and pleasantly in the Woman’s Hospital of Philadelphia, her friends and acquaintances await impatiently for the coming of the first woman doctor in the state. he impatience is due more to curiosity than any substantial interest.[40]Compare Alexander’s identical fear expressed to her father in 1885 (quoted above). With few exceptions every woman has said, “I hope she will succeed, but I could never trust a woman when I and my children are sick.” Mary Barry was the first of her friends to call. After the first greetings and asking and answering questions, Mary said, “Katherine you are to have a call soon from Mrs. Blake. I heard her say the day you came home she wanted you to attend her in her next sickness.” “They are new people here are they not?” “Yes, they came here from Kentucky two years ago. They have had very little sickness and have had your father Dr. Caldwell when they needed a physician. So look out for a call from her soon. By the way Katherine, she thinks you are a middle aged gray haired woman instead of a young girl of twenty-two with yellow hair and innocent baby eyes.” “Oh for old age and grey hairs,” laughed Katherine. “I suppose you have heard of Will Herndon’s success,” said Mary rising to go. “He deserves success.” “Yes, shortly after going to Peoria old Doctor Pratt took him into partnership with him and within the year the old doctor kindly went to heaven leaving his large practice in Will’s hands. His sister tells me he writes he is very busy and wishes he had a certain doctor whom he knows for a partner.” “I am glad to hear of his success, he deserves the best of everything. His nobility of character and tender sympathetic nature will endear him to his patients.” “A note for Doctor Caldwell,” said a voice at the door a few days later. “Dear me,” said Katherine, “suppose it is the call from Mrs. Blake.” Taking the note from the servant’s hand she read: “Dear Doctor = Please call to see my wife as soon as possible. Yours, J. D. Blake.” “I wonder if it means me or father, it just says ‘Dr. Caldwell,’ and father is out. Mary Barry said they were going to send for me, so I’ll risk it and go.” She hurried on her hat and gloves, picked up her little black satchel which had been filled with all things needful anticipating this call and in twenty minutes rapped at Mrs. Blake’s door. “I wish to see Mrs. Blake,” she said to an old lady who opened the door. “My daughter is sick, bad off, and we’ve sent for the doctor, whom I expect every minute.” “I am here madam, I am Doctor Katherine Caldwell.” “You – Doctor Caldwell?” said the old lady in open eyed astonishment. “Why I supposed Miss Doctor Caldwell was – was –.” “That’s all right madam, I received Mr. Blake’s note asking me to call. Will you show me to Mrs. Blake’s room?” Dr. Katherine followed the old lady into the sick room. “Mary this is Miss Caldwell, Miss Doctor Katherine Caldwell.” Mrs. Blake turned her head to look at the woman doctor. “Mother,” she said, “where is the doctor?” “I am the doctor,” said Katherine, quickly drawing off her gloves and going to the bedside. “Oh! O—O— Oh—!! Why didn’t your father come? Mother sent for Doctor Caldwell.” “Dr. Caldwell is not at home,” said Dr. Katherine. “If I have made a mistake and am not wanted, I will bid you good morning,” picking up her little black satchel to go. The mother quickly laid her hand on the doctor’s arm and said, “Don’t go Miss Doctor, excuse Mary’s talk, she is suffering so she does not know what she is saying, please stay and do something for her.” Reluctantly Doctor Katherine stayed, fearing that if all did not go well that it would hazard her success in that most historic of Southern towns where such an innovation as a woman doctor was not looked upon with much favor. Oh! The mental agony and physical anguish of doctor and patient during the next half hour. It seemed hours to both. The anxiety and pain are at last ended with a heartfelt “Thank God,” and a feeble infant cry in a peculiar minor key. Dr. Katherine left the house an hour later, the patient happy with her little pink baby on her arm, and the new grandmother blessing and praising women doctors in general and “Miss Doctor Katherine” in particular. On calling the next day Mrs. Blake said, “Doctor you must pardon the way I acted toward you yesterday. You looked so young, so pale and scared that I became frightened myself. I feel well this morning. You have my entire confidence and will have my practice in the future.” That was Doctor Katherine’s first patient, the successful issue of which was the beginning of a successful career.

* * * * * * * * *

Three years passed, each succeeding one being more successful than the last. Doctor Katherine is devoted to her work. Her special delight is with little children who love her as their best friend. As she drives through the shady streets one hears on all sides “Hello Doctor Katherine” from these little friends of hers. [41]Identical stories were later told of “Dr. Annie” by her former child patients (cf. Blythe; Thompson 14). She has had a trying week. A terrible epidemic is scourging the city. Many adults and children have succumbed to the grim Angel. Returning home one morning after spending the night with a desperately ill mother and dying babe, she finds a letter from Doctor Will Herndon. A blush creeps into her pale cheeks. She hesitates before reading it. Tired and exhausted she throws herself on the lounge in her office. Suffering and joy, death and life, happiness and sorrow mingle painfully in her thoughts. She reads the letter the second time. Falling asleep the last lines mingle in her dreams. “You are more than wealth or life itself to me Katherine. All that Peoria needs to make it the hub of the universe is a nice little woman doctor. Won’t you come?” Bella Donna