Fifty Years a Surgeon: Bertha Van Hoosen and the Campaign for Painless Birth.

One of the greatest revolutions of the Twentieth Century in the relief of the intense pains of childbirth came under the most unassuming of names: Twilight Sleep. First developed by Carl Gauss and Bernhardt Kronig in 1903, building on the work of Richard von Steinbuchel, Twilight Sleep was a method of anesthesia that, in the hands of a skilled practitioner, promised the best of both the natural birth methods that have been practiced since time immemorial, and of the complete knock-out methods developed in the mid-19th century that included chloroform. Unlike with chloroform, patients under Twilight Sleep still underwent their normal contractions and muscular promotions, which allowed for better outcomes and faster recoveries, but, notably, without any memory of having undergone pain.

For the first two decades of the Twentieth Century, Twilight Sleep was the most sought after method for giving birth in the United States, sparking a paradigm shift in how and where babies were born in the nation that could not be turned back even after that particular method lost its ascendancy, and at the center of this revolution in child birth there stood one of the nation’s most respected surgeons, Bertha Van Hoosen (1863-1952). The founder of the American Medical Women’s Association, a strong voice in the adoption of antiseptic surgical practices, and a central figure in the turn of the century Chicago medical scene whose services were in demand the world over, Van Hoosen was a veritable force in modern surgery, who used the respect that she garnered to advocate for the removal of all racist and sexist practices from medical institutions (and this at a time when other doctors were actively engaged in eugenical theory), and to push for the training of medical staff in Twilight Sleep (otherwise known as the Freiburg Method) practices to make childbirth safer for the mother and child, and to lessen the regular trauma on obstetricians who are called upon, day in and day, to absorb all of the stress and concern of entire families and still produce positive results, an insight into the need for practices that recognize the importance of medical staff mental health that was a solid century ahead of its time.

Part of Van Hoosen’s confidence in her abilities and insights came from her family and her upbringing. She was raised in Stony Creek, Michigan, a tiny community which her ancestors had carved from the wild forest decades before. She experienced all of the facets of early American rural life, including a ready familiarity with the facts of reproduction and death, unvarnished by all of the Victorian obfuscations which urban girls her age were laden with. She knew that sex made babies, and witnessed for herself the biological processes behind birth, encouraged by her atheist farmer father, who delighted in her matter-of-fact curiosity and intelligence. She did well in school, and had a particular knack for languages that led her to enter the University of Michigan in 1880 in the Literary Department. At first, her goal was to treat college as a social experience, as many women did in her day, and she took the minimum class load, filled only with classes that were virtually guaranteed A’s (called ‘snaps’ in the parlance of the time), so that she could spend as much time as possible on entertainment. Her Junior year, however, she decided that it was time to get down to the business of creating a future for herself, and resolved to follow up on her inclination to become a doctor, shifting gears entirely into academic mode, taking as many hard-core chemistry and toxicology classes as the university would allow, while keeping her new medical focus a secret from her friends for as long as possible.

Her new choice of career, while acceptable to her father, was a source of deep sadness and anxiety to her mother, who clung to the hope that Bertha would follow in the traditional footsteps of her sister Alice and become a teacher. Bertha’s father believed that he could not support something that actively distressed her mother, and removed all financial support for her further education, pushing Van Hoosen to a life of self-sufficiency through a complicated web of temporary medical opportunities, each of which contributed to the wide experience base that she brought to her eventual practice.

Van Hoosen graduated in 1884 with her AB, and took up an offer from Dr. Mary McLean (1861-1930) to teach calisthenics for the summer in St. Louis, continuing her medical education by attending demonstrations. McLean was just establishing her private practice (she was in fact the first woman doctor to practice in a hospital in St. Louis), which due to prejudice against women doctors saw no clients for months upon months, compelling the pair to live on minimal rations. This was Van Hoosen’s first experience with rapidly prepping a class in a subject she had no experience in order to scrape together enough money to continue her studies, and it would not be her last. 

In 1885, she entered the University of Michigan Medical School, where she had the good fortune of learning anatomy from Corydon L. Ford (1813-1894), whose clarity and exactitude provided her with a solid foundation to her own long career as an anatomy lecturer and demonstrator. While pushing through with her studies, she grabbed any chance to shore up her finances that presented itself, working as a student nurse at Detroit’s Woman’s Hospital, as a math and German teacher in Saginaw, Michigan, and as the demonstrator of anatomy at U of M’s Medical School. Though often down to her last few pennies, and having to take off months at a time to build up her financial reserves, she received her medical degree in 1888, and headed on to her residency at the Woman’s Hospital where she had previously served as a student nurse. 

Here began four years of experiencing a wide variety of medical positions, following opportunities as they arose. At the Woman’s Hospital, she worked with women who were having children out of wedlock, where it was standard policy to take the children away from the mothers and give them away to other homes after birth, a policy Van Hoosen would later question when she came into contact with programs that allowed the mothers to go to the countryside and raise their children while learning new skills. Here she had to deal with doctors who did not believe in the germ theory, while she herself was keenly aware of anything that might bring dangerous microbes into the birthing environment. 

Her next appointment was a complete shift of focus, taking up a position offered her by Dr. Mary Black Palmer as assistant physician at the Kalamazoo State Hospital, a mental facility that was experimenting with less physical restraint of patients, and more structured freedom dependent on the sharply trained skills and sense of duty of the nurse attendants. This was sometimes frightening, always fascinating, work, but though Van Hoosen learned much about the breadth of the human mental experience while working at Kalamazoo, she did not see this as her future path, and when the opportunity to work at the New England Hospital for Women and Children (the hospital founded by Marie Zakrzewska in 1862 to bring the same services to Boston that the Blackwell sisters had brought to New York with the New York Infirmary for Indigent Women and Children in 1857) as a resident arose, she grabbed it, seizing every opportunity she could while there to carry out a variety of surgeries.

By 1892, she was ready to settle down and establish her own private practice, but the great question was where. She had relatives and connections in St. Louis, Boston, Detroit, and Milwaukee, but ultimately chose none of them, spontaneously settling on Chicago while on the process of passing through the city on her way to Milwaukee. She loved Chicago on sight and decided to establish her practice there, in spite of the complete lack of a support network. She was warned that women doctors just starting in Chicago could look forward to years of no clients, culminating in a grand flame-out, but her personal rigor and honesty won her an early following. While other, more jaded, doctors in the region advised her to just subscribe sugar pills to patients in lieu of taking the time to teach them more complex but actually useful practices of self and infant care, Van Hoosen felt that it was her duty to instruct new mothers and provide them with the means of implementing her advice. This approach took every moment of her time, but her results, spread from ear to ear by immigrant mothers impressed by the fact that a doctor actually listened to their problems and trusted to their intelligence to follow medical instructions, caused her practice to boom. She became something of a local legend, heading out at all times of day and night with her horse Kit and part-fox dog Fritz to make house calls.

But of course, Van Hoosen was never satisfied doing just one thing. Keeping track of the number of simultaneous appointments Van Hoosen held at any given time is an absolute nightmare for her biographers, and a testament to her lifelong generosity with her time, skill, and knowledge. While running her private practice, she also at one point or another ran the gynecological and obstetrical dispensary clinic at the Columbia Dispensary, taught embryology at the Woman’s Medical School, acted as emergency physician at the Columbian Exposition, demonstrated anatomy at Northwestern University Woman’s Medical School, helped train minority nurses as a staff member at Provident Hospital, and worked as a gynecological clinical assistant at the Charity Hospital and as a staff worker at Wesley Hospital. 

All of this activity sharpened Van Hoosen’s skills as a surgeon and obstetrician, and prepared her for her first long term appointment in 1902, as Professor of Clinical Gynecology at the College of Physicians and Surgeons, where she overcame the initial resistance and outright hostility of the student body by ensuring that her first surgical demonstration was of such a rare medical phenomenon that students could not resist the pull of curiosity, changing a demonstration at first populated by zero individuals into a must-attend event that drew faculty and students alike, and ensured that never again would Van Hoosen have to worry about attendance at her weekly surgical clinics.

Though the students overcame their gender prejudice in the face of Van Hoosen’s experience and competence, the hospital that contracted with the College did not, and did everything they could to prevent individuals from the hospital from being moved to the College for the purpose of Van Hoosen’s demonstrations, including physically locking doors to prevent their transportation, a problem she overcame by establishing her own small hospital, dubbed the Gyneceum. 

It was here, at the Gyneceum, that Van Hoosen experimented with Twilight Sleep as a promising new means of allowing a patient’s body to undergo the regular processes of a birth while preventing their mind from undergoing the traumas of the pain associated therewith. This method was not a simple one - those administering the scopolamine had to finely adjust the dosage over time, and tightly regulate the environment of the patient to achieve optimal results. The advantages, however, were well worth the trouble, both for the patient-child dyad, who experienced less trauma and saw better results, and for the attending doctors, who were saved the regular trauma of dealing with individuals in intense pain and their concerned families. Van Hoosen’s students demonstrated that the method could be carried out not only in the hospital setting, but in the home. Yet overwhelmingly it was hospitals that offered Twilight Sleep, driving a spike in preference for hospital over home birth. For centuries, hospital births were considered by mothers as next to death sentences for themselves and their children, thanks to unsanitary practices, but between advances in antiseptic protocols, and the ability to give birth without memories of pain, a seismic shift was taking place, towards a future where pain-managed, hospital birth preceded by regularly monitored pre-natal care, would be the norm, with corresponding improvements in infant and mother mortality rates.

In 1913, Van Hoosen attained the post of chief of gynecology at Cook County Hospital, and parlayed her influence into the creation in 1915 of the American Medical Women’s Association, an organization which was meant to ensure that rising women students would not have to face the labyrinth of restricted opportunities that Van Hoosen and her generation had weathered. The AMWA was tireless in putting pressure on hospitals, the vast majority of which did not admit women as medical interns, to revise their policies, while providing financial resources for new students and dedicating resources to combatting false narratives about women doctors as unfeminine, quasi-criminal individuals. 

While all of that was going on, Van Hoosen was also making a name for herself as a lecturer about sex education, crafting talks about human reproduction that, by starting with an undifferentiated mass of cells and slowly acclimating the audience to the development of sex organs, brought even the most squeamish and Victorian of students to a more complete knowledge of their biologies and the processes of reproduction, allowing them to make more informed choices about their futures. 

Van Hoosen was worried that, for all the good she had done as a surgeon, the real legacy of any gifted doctor was in the people they had trained to take their place, and at Cook’s she developed a program of junior and senior assistants that allowed aspiring doctors to work their way towards higher levels of surgical responsibility, training dozens of new surgeons in this method without any regard to race or creed, including Li Yuin Tsao (1886-1922) and future celebrity doctor Margaret Chung (1889-1959). In the 1920s, Van Hoosen would travel through China and Japan, performing surgeries and encouraging the women doctors there as part of her personal mission to see that women the world over achieve professional success in the medical profession.

In 1947, at the age of 84, Bertha Van Hoosen published Petticoat Surgeon, her memoir of her remarkable life fighting for better racial and gender equality in doctoring, more hygienic and painless methods of surgery, and greater standardization across hospitals to produce more regular results in surgical procedures. She passed away in 1952 at the age of 92, but that book has proven evergreen, republished in 1968, then again in 1983, then again in 1994, and 2015, and 2021, bringing her story to new generations and keeping her in our minds in a way that has been largely denied to her contemporaries. We keep coming back to Van Hoosen, the frontier girl who grew up to be a surgeon whose methods had a global impact, and her vision of an international community of women doctors pushing forwards the bounds of compassionate, informed care has become the reality we now enjoy.

FURTHER READING:

Petticoat Surgeon is a wonderful book, free of many of the more overt prejudices that weigh down other memoirs of women doctors of this era. Van Hoosen celebrated all people, and accepted no separation or difference in their care. It has been reprinted so many times that copies are available all over the place for pretty cheap. In addition, in 2016 Detroit PBS produced a documentary about the Van Hoosen farm that is still available to watch for free online.