1853. Richmond, VA. Therein occurred, according to John A. Cunningham, M.D., a most remarkable case, one equally deserving of permanent record as those found published the prior decade in Dr. Campbell’s Memoir on Extra Uterine Pregnancy.
“There were no reasons to lead us to suspect what afterwards turned out to be the true condition of things, and we therefore treated her for the rectal irritation, and in the usual way,” Cunningham wrote. Usual way? Apparently it was so “usual” that it didn’t warrant any explanation. Nor did it grant relief.
In fact, in the days afterward, “discharges from her bowels became offensive and filled with purulent matter.” Before going any further, it should be noted that physicians of that period rather differ from those of today. Colleges then operated on something akin to the honor system, and training was not actually required. For a small fee, most any man could get a license. The dismal pay, however, lured only a few.
As such, the licensed were a dedicated lot. Except for treating women “down there.” Even in life or death matters, whether credentialed or not, death, was preferable to immorality. When Dr. Ephraim McDowell of Kentucky defied convention and saved Mrs. Crawford by removing an ovarian tumor—the first known attempt of the surgery—a mob encircled the house and threatened his life. “Get a rope ready! No woman-butcher will leave Green county alive!”
If a man couldn’t or wouldn’t treat a woman, then Elizabeth Blackwell reasoned she would. After applying to medical school in New York, her acceptance was put up for a vote, and all the medical class raised their hands and cheered, thinking it must be some joke. But when she walked into class the first day, the joke was on them. She graduated and her sister followed soon after.
Dr. Cunningham doesn’t mention any of this in his report published in the Virginia Surgical and Medical Journal, though he certainly does not shy away from details. “We were desired to visit an old negro woman, who had been the cook for one of the largest families in this city for probably fifty years and whose office during that long period of time had certainly been no sincecure.” I had to look up “sinecure.” It basically means a soft, cushy job with good pay and benefits. As to what this had to do with anything extra uterine, well your guess is as good as mine.
The good doctor continues: “After serving in this capacity as long as she was able to perform the duties, she was now at the advanced age of 80 or 85, a superannuated dependent on her master. As is common with negroes, she did not know precisely how old she was, but we think that the estimate of her age we have made is correct.”
Although her state of mind was “somewhat impaired” unlike her general health (“remarkably good [and] had given way only in the last few months), she was “somewhat enfeebled by a long continued pain in the loins, accompanied by great irritability of the rectum and anus, with a constant tendency to stool, and she complained greatly of the tenemus and straining.” Tenemus, I’m sorry to report, can be defined as the feeling that you’ve not completely emptied your bowels. But wait. Her true condition gets worse. One morning Dr. Cunningham was amazed to hear from her nurse, that the old woman “had been for some days passing bones of different sizes and shapes, none of which she had preserved.” Cunningham at once instructed that she should “keep whatever substances of that sort she might evacuate from the rectum” and “in a day or two she brought us quite a number of bones, evidently those of a fetus, completely denuded of flesh, and surrounded by a slimy and purulent material. These bones were collected for some time, and some of which we now have are mostly the phalanges of the fingers and toes; others are evidently the heads of the long bones imperfectly ossified, and some apparently portions of the pelvis and other of the flat bones.” “We inquired of the patient whether she had ever though herself pregnant and afterwards believed herself mistaken, but she remembered nothing which could be made to bear upon the point. The only fact of interest was elicited from a fellow servant who had lived with her many years, and who informed us that the cook had often complained of having a tumor in her belly which troubled her. We ascertained from her owner that she had been the mother of several children.” Cunningham concluded the fetal material came from an extra-uterine pregnancy, which after remaining in abeyance not less than forty years, and “interfering but little if at all with her general health, had at last been discharged by ulceration of the sac which contained it, forming a fistulous opening into the rectum and giving rise to all the symptoms described.” But here’s the thing: Did anyone wonder about the discharge of her other children, or the effect it had when they were ripped from her arms, some still suckling at her breast? It would be another decade before the South’s ulceration came to a head and erupted, splitting a nation wide-open from the inside out. Until then, some mothers had no choice about the fate of their babies and barely held on. Some held on for as long as they were able. Maybe some held on in ways we’ll never understand. Cunningham’s diagnosis may have been accurate, but I’m not sure it’s complete. If he were interested in her true condition, then he might have taken something else into account: Love between a mother and her child is always a tug of war, a constant push and pull from start to finish, but that doesn’t make it a disease, even when it tears us to pieces.