16

Carrying On: Martha May Eliot, M.D.

It is dangerous for an innocent girl to take long trips with an active homosexual woman, who though cultured on the surface may have a tendency to seduce girls. . . . Girls should avoid older women who are fond of them, especially if they attempt any undue intimacies.

—John Meagher, 1929

 

You take with you the deep satisfactions that you have so rightfully earned for the splendid leadership you have given over the years to the cause of better health and welfare for children, not only in your own Nation but around the world. . . . Future generations of children will be the beneficiaries, as past generations have been, of the forward-looking and selfless service you have given on their behalf for 30 years.

—President Eisenhower to Dr. Eliot on her retirement from the Children’s Bureau, 1957

 

Working as a Team

BY 1891, THE YEAR Martha May Eliot was born, Emily Blackwell, Jane Addams, and Carey Thomas had already accomplished a great deal to enlarge the prospects of American women. But in the half-century between 1920 and 1970, it seemed that what those pioneers had accomplished would go largely unheeded and unappreciated. Nevertheless, Dr. Martha May Eliot and a few women like her were their beneficiaries and by their own successes managed to keep the victories of the earlier generation flickering through the dim years. Eliot, who died in 1978, even lived long enough to witness that flicker turn to a flare again, in a new movement that encouraged unprecedented numbers of women to take up the rekindled torches, which lit their way into medicine and other professions.

Martha May Eliot—a distant relative of Charles Eliot, the president of Harvard and sworn enemy of M. Carey Thomas—was denied entrance to Harvard Medical School because she was a woman. Johns Hopkins University had to accept her under the terms of Mary Garrett’s endowment, which had been negotiated by Carey Thomas, and she received her medical degree from Johns Hopkins in 1918. Her impressive successes, which followed soon after, certainly had no effect on her uncle Charles’s opinions about the appropriateness of serious study for women; at just about the time she became the first resident doctor at Yale University’s newly established department of pediatrics, he was writing that “the prime motive of the higher education of women” should be to develop “the capacities and powers which will fit them to make family life . . . happier.” Martha carried on in spite of her venerable relative.

Though Martha Eliot devoted her career to the health of children, family life in a conventional sense never had interest for her. Her earliest memories were of wanting to escape from the usual parameters of little girlhood in the late nineteenth century—“to leave home. Go out and see things. Go out and see the world.” Among her papers was a school essay written by a friend in 1907, which she saved for the next seventy-one years and passed on for archival preservation. The essay, “The Importance of Purpose in the Life of a Girl,” declared that girls often have grand ambitions when they are young that get lost when they become fifteen or sixteen. “Boys as a matter of course have to pass their college examinations and while they are young they must work for this and arrange the rest of their lives to suit them best for this end.” But girls, the author complained, are permitted by society to be directionless. The essay concluded with a plea that girls too be given something to strive for. Martha Eliot, who was sixteen in 1907, took the essay to heart, vowing that she would never be distracted from her own grand ambitions.

Marriage would have been the ultimate distraction. While in medical school, when Martha received word from her mother that a cousin had announced her engagement, she reiterated her determination in no uncertain terms: “When I announce my engagement, we can take the paint off the front of the house!! but to tell you the truth, if some other opportunity comes for getting it done, don’t wait for me.” By then her mother undoubtedly did not have to be admonished that her daughter would not be announcing her engagement. Martha had set her course against marriage years earlier and had refused to swerve from it. Yet while heterosexuality could not tempt her, relationships with other women, which would not threaten her ambitions as marriage would, did have power over her. In high school, for instance, she had a romantic friendship with a girl who later became a Bryn Mawr College student. Martha’s parents sent her to Radcliffe, but after the first year she took a leave in order to spend her sophomore year at Bryn Mawr with her friend. As she recalled when she was eighty-three years old, the dean at Radcliffe, who had “thought I was pretty queer to want to do this,” had tried to dissuade her from leaving Radcliffe by threatening to record her Bryn Mawr courses with no grade higher than C, but she went off to Bryn Mawr anyway.

The romantic friendship that took her to Bryn Mawr was short-lived. However, there she met a twenty-six-year-old freshman, Ethel Dunham, who had gone to college after eight years of a pointless social life as the unmarried daughter of the president of Hartford Electric Light Company. Ethel found her direction at Bryn Mawr—together with Martha. From 1910 to Ethel’s death, in 1969, the two women were inseparable. They decided, very possibly under the influence of the redoubtable Carey Thomas, that they would go to medical school together, practice together, and live together for the rest of their lives. As Martha remembered sixty-four years later, “So that year in Bryn Mawr was productive for me in more than one way.”

As a couple, Martha Eliot and Ethel Dunham provide an interesting illustration of how a few women were able to carry into the twentieth century the legacies of the pioneers. The heterosexual imperative of 1920–1970 seemed to pass them by, just as all the other social strictures that prevented most bright women from pursuing serious careers during those years did. Eliot and Dunham succeeded in times that were as unsympathetic to professional women as they were to lesbians. Yet they both seemed to be almost oblivious to the ethos that said that they were not supposed to have ambitions that were not domestic, they were not supposed to succeed, and they were certainly not supposed to want and be able to make their lives with each other. Their story can be seen as paradigmatic of how what was not supposed to be doable could be done if it was desired enough.

After Martha Eliot and Ethel Dunham met, their professional and personal lives invariably depended on each other. Martha, who had started college a year before Ethel, graduated from Radcliffe in 1913, but she did not go to medical school immediately, because she wanted to begin with Ethel. Waiting for Ethel to graduate, she took a job as a social worker at Massachusetts General Hospital. (How would she have supported herself that year if women such as Jane Addams had not opened a profession of social work for women?) When Ethel graduated, in 1914, they entered Johns Hopkins Medical School together, two of eleven women in a class with eighty-four men.

The open hostility visited on Emily Blackwell when she tried to get a medical education in the mid-nineteenth century had long passed. But it must nevertheless have been extremely difficult to be part of a small minority studying for a profession in which women were still far from accepted or prominent. “We [Ethel and herself] braved the dangers of the School office this morning and only encountered one male student,” Martha wrote to her mother nervously, shortly after arriving at Johns Hopkins. The female students banded together. They were helped by Carey Thomas and Mary Garrett, who, as the medical historian Regina Morantz-Sanchez characterizes it, “continued a watchful scrutiny over the Hopkins women and obsessively monitored their success.” Martha Eliot’s letters show to what a great extent Carey Thomas remained a salient presence at Johns Hopkins, even after Garrett’s death, in 1915. Martha reported that Thomas attended teas given by the Women’s Committee of the Medical School, listened receptively to the students’ problems and suggestions, and continued to provide money for their benefit, such as the $10,000 she donated in 1917 for the building of the Garrett Room, a gathering place for female medical students.

Martha and Ethel were also able to alleviate the alienation of being women at a medical school that was primarily male by making a home together from the start, in an off-campus apartment. Their domestic satisfaction crept constantly into Martha’s letters home: “E. and I get our own breakfast now and so start out earlier and better for the day’s work”; “E. keeps me out doors which is great. This P.M. we are going canoeing”; “Tonight we are having supper here—oyster omelet, a concoction of Ethel’s—and apple sauce and toast and nutbread.” They shared everything. They cheered each other on through the difficulties of dissection and bandaging and late-night studies. Ethel bought a car and taught Martha how to drive. Together they even kept the suffrage movement going at Johns Hopkins. At Bryn Mawr, under Carey Thomas, they had become committed to the cause; in Baltimore they worked at suffrage bazaars and distributed suffrage literature together.

Because Martha Eliot was among the top 10 percent of her class in 1918, she was nominated for an internship at Johns Hopkins Hospital before graduation. However, she turned it down. As she wrote to her mother, “Part of my reason for my lack of enthusiasm was because Ethel didn’t get an appointment. I was frightfully disappointed.” Because she hoped that Ethel might be accepted at Massachusetts General, Martha finally took an internship at Peter Brigham Hospital in Boston, where no female doctors had been accepted before. Ironically, Ethel was then informed that she would be accepted at Johns Hopkins Hospital after all. Many of the male students had gone into the Army Medical Corps when the United States entered World War I, so, as Martha wrote with some bitterness, “it didn’t leave so very many to choose from for internships and hence the girls had a good show.”

Although Martha knew she was lucky to have gotten the Peter Brigham internship, she was in despair at being separated from Ethel. Through much of that year, she schemed over ways for them to be together, but the next year was even more difficult. Ethel became one of the first female house officers at the New Haven Hospital in Connecticut, and Martha undertook a residency in pediatrics at St. Louis Children’s Hospital in Missouri. That year too was spent in wishing they could be together and working at every opportunity to make that possible.

By 1920 Martha was feeling desperate, as she wrote to her mother in a remarkable letter, which may be read as the closest thing to coming out that a woman of her day and class would have been capable of.

 

You will be interested to know that after much changing of mind and many mental gymnastics and more hours of thought I have come to the conclusion that I will come back to Boston next year and see what’s to be done there and try to find out what the future will bring forth not only for me but for Ethel too. It has taken a great deal of arguing with myself to give up the place [in St. Louis], but I believe I am right. . . . My idea is that by another year [in Boston] I will know things well enough to find work that Ethel will like, and then she will come up, I hope, and we can have a little apartment together such as we have always planned.

 

Martha went on to make clear to her mother that “I am not as I was seven years ago [before she made the decision to delay her entrance into Johns Hopkins until Ethel could go with her]. The values of life have changed very much for me and I have got to live accordingly.” The plans she outlined in the rest of this letter, both short-term and long-term, centered on Ethel. For example, she would visit her parents, she wrote, if Ethel would come with her, “but I must confess that unless she wants to do that I will want to stay with her in Keene Valley [where Ethel was spending her summer vacation].” Martha’s letters home had been shared with the entire family in the past, as she knew. But this letter she ended with a statement that suggested she did not wish to come out to her other family members: “This letter is for your own benefit and not for general perusal or to be read out loud.”

Her dependence on Ethel was perhaps not very different emotionally from what many women experienced toward men. She had difficulty envisioning her life without Ethel. She was willing to sacrifice almost everything for the sake of their “marriage.” Nothing satisfied her as much as their connection to each other. However, as was true for the pioneering women of the generations before hers, the ways in which Martha’s relationship with Ethel differed from heterosexual relationships of their day mandated that Martha try to become a professional success. Women who were interested in heterosexuality usually gave up medical careers, as they were generally expected to do, when they married. Even more likely, women in the early years of the twentieth century who believed that heterosexual marriage was essential to their happiness would surely not even have started medical study in the first place, despite their aptitude, because they knew that a career as a doctor would be incompatible with their eventual roles as wife and mother. They would have considered that among women who practiced medicine, only about 30 percent were married, and they would have decided that such a career was not for them.

In contrast to heterosexual women, the only way Martha could maintain her primary relationship during these crucial years was to go through medical school with Ethel, become self-supporting, and find a position near her. Martha’s lesbianism was thus instrumental in helping her realize the other great passion of her life: to become a doctor. If she had not qualified for a profession, she would have had to return to the bosom of her family. Eventually, perhaps, she would have been coerced to bend to their wishes to “take the paint off the front of the house!!” despite her lack of interest in heterosexual life. Her emotional dependency on Ethel made her brilliant career not only possible but necessary.

Martha returned to Boston from St. Louis, as she told her mother she would, and set up a private family practice, hoping to find a way to bring Ethel to Boston. It was still a difficult time for her. She was uncertain about when she and Ethel would be able to be together again, and she was not happy in private practice. She felt especially uncomfortable because she was pressured by male doctors to charge higher fees—fees comparable to their own—when she was already thinking that her fees were too high and that “it was frustrating not to be able to accomplish all the things for the families . . . like laboratory work or x-ray which some could not afford.” But at the height of her personal and professional discontent, a miracle happened—or her persistence paid off. Her former professor at Johns Hopkins was establishing a department of pediatrics at Yale, in New Haven, where Ethel was, and he invited Martha to be its first resident doctor.

The only drawback was that the position required Martha to live in the university hospital. Yet she managed to take many of her meals and to sleep often in Ethel’s apartment. “I spent the night with Ethel and shall return there again tonight”; “[Ethel’s] maid is very good and has no objection to my dining there very frequently so I shall continue to do so several times a week”; “I came over here tonight to have supper with Ethel after a busy day in the hospital and it is very refreshing,” Martha wrote to her mother, usually on stationery stamped “Ethel C. Dunham, M.D.” She desperately needed the comfort of Ethel in the midst of her demanding work.

 

Bringing the Jane Addams Influence into the Medical Profession

However, Martha and Ethel still did not have the home together that Martha craved. That longing continued to influence the trajectory of her career. “Whether I shall stay on at the hospital is not yet settled,” she wrote in March 1923. “I am contemplating taking on some work with rickets which would let me live outside.” She may have first planned to work on rickets, largely a disease of poor children, because that would give her the freedom to live with Ethel, but the move was entirely consistent with Martha Eliot’s view of the social duties of a medical doctor. Even while in medical school, she had tried to arrange her packed schedule so she could do volunteer work at a children’s clinic. “I sometimes get wild to have something to do that . . . isn’t purely for my own satisfaction,” she wrote in 1914, echoing Jane Addams. And again in 1915, “I have had a strong feeling right along that every chance I could get to do any social work would be more than worthwhile . . . If I should practice I want to keep attached to the social end of it, in other words, be some kind of a ‘social doctor.’” Her research on the prevention of rickets among economically deprived children stemmed from that impulse.

This project was revolutionary for its day. As the American Journal of Public Health observed in 1971 of Martha Eliot’s early rickets work, “Those of us who have grown up with scientific clinical investigation may find it difficult to appreciate the courage and imagination required in such studies [fifty years ago].” There was little tradition for this kind of investigation. Eliot had to develop her designs almost from scratch; her training at Johns Hopkins had included nothing about community health research. Work such as hers became a model for later researchers.

Martha Eliot’s rickets project not only allowed her to live with Ethel; it also launched her career in community pediatrics and then in administrative medicine. The rickets study was funded by the Sheppard-Towner Act, a maternal and infant care bill that had been passed through the efforts of activists such as Jane Addams and her protégés. It was administered by the U.S. Children’s Bureau (which also owed its existence to the persistence of Addams and her colleagues). The bureau had been established by Congress in 1912 to investigate and make recommendations on infant mortality, child labor, and all other issues pertaining to child welfare. Martha Eliot’s research on rickets resulted in her being named director of the Child Hygiene Division of the Children’s Bureau in 1924.

This appointment might have led to a crisis in her relationship with Ethel Dunham. The Children’s Bureau headquarters were in Washington, D.C. While Ethel may have been footloose earlier in her career, in 1924 she became one of the first female professors at Yale University’s School of Medicine. A couple in a heterosexual marriage with a comparable dilemma would perhaps have assumed that someone would have to sacrifice something—and it would undoubtedly have been the wife, who would have forgone her advancement for the sake of the family. As Morantz-Sanchez has shown, in the early generations of female doctors, those who married usually were constrained by the various demands of their situation to modify their careers drastically. Such a possibility did not even occur to Dunham and Eliot. They had to find a way to work it out so that they could both keep their jobs and yet remain together.

Martha Eliot’s success at finding a solution was surely due in good part to luck, but pluck and determination cannot be discounted. She argued with validity that her New Haven rickets study was ongoing—she continued it for ten years, until 1933—and that she could not give up teaching at Yale, which she had recently undertaken. (In addition to being attending pediatrician at the hospital, she eventually rose to the rank of associate professor at the Yale Medical School.) Her arguments were persuasive. She arranged with the Children’s Bureau to travel to Washington once a month and stay for three or four days to give hands-on guidance to the Child Hygiene Division. The rest of her work for the division would be done at a distance, from New Haven. She and Ethel were therefore able to remain at Yale until 1935, when Martha was appointed assistant chief of the bureau and had to be in Washington full-time. In 1951, with the consent of the Senate, President Truman named her chief of the Children’s Bureau.

Throughout the intervening years, both Martha and Ethel conducted intense careers that often placed them under great pressure. But they seem to have believed that their relationship gave them sustenance for the challenges and that their work and their life together were inextricably connected. For example, in 1923, just before they were to go off on a vacation to England, Martha learned that she had received funding for her rickets project. But “Excitement no. 2,” as she described it in a letter, which came at the same time and was fully as important to her as “Excitement no. 1,” was “the little house we were looking at, and as the owner has come across with everything we asked . . . we will probably move in!”

Martha’s letters leave a close record of how the two women managed to combine the home life they needed during those years with their varying duties and long-distance commutes. For example, in the midst of committee work, lectures, administrative tasks, sick patients, travel, research, and writing, “we brought down a box full of plants from the Dunhams’ garden—pansies, forget-me-nots, sweet williams, canterbury bells, English daisies—and yellow lilies. Our garden will be very superior if they all grow.” They read books out loud to each other. They learned to play the piano together. They planned their professional trips together as much as possible; when Ethel visited a tuberculosis sanitarium in Minnesota for a project on infant tuberculosis, for instance, Martha visited a child welfare institute at the University of Minnesota.

They shared a phenomenal energy level and good health, which permitted them both to make remarkable accomplishments. Ethel Dunham became an expert on premature babies. In 1927 (undoubtedly in part through Martha’s influence, but primarily through her own abilities), she was appointed the Children’s Bureau’s medical officer in charge of neonatal studies. This meant that she and Martha could travel to Washington together every month, though like Martha, she retained her position at Yale and conducted her neonatal studies in New Haven. They continued living in their little house with its flourishing garden.

When Martha became assistant chief of the Children’s Bureau in 1935, Ethel was able to make her own career run parallel once again. They both gave up their Yale positions, and Ethel became director of the division of child development research in the Children’s Bureau. She more than earned this promotion, establishing national standards for the treatment of premature infants, developing a model program to extend the care of infants from the hospital to the community by public health nurses and social workers, and writing a pioneering work on hospital care of newborns, which became one of the most widely distributed publications ever sponsored by the American Pediatric Association. She was made the first female member of the American Pediatric Society and in 1957 became the first woman to be honored with its highest award, the Howland Medal.

In the years following her appointment as assistant chief, Martha Eliot was especially interested in the interrelationship of child health and socioeconomic factors, and her particular concern was with obtaining better medical services for children of low-income families. She was an advocate for all children, appearing before countless congressional committees whenever legislation was proposed for child welfare. She argued tirelessly for universal health care for the young, and many of her proposals were eventually incorporated into law. She served as the chief architect of health provisions for children in the 1935 Social Security Act, which mandated that every state establish child health services.

Her interests and contributions spread beyond American children, as President Eisenhower noted when she retired. After World War II, in 1946, she served as the vice chair of the U.S. delegation to the International Health Conference and on behalf of the United States signed the constitution that established the World Health Organization. (She was the only woman to sign WHO’s constitution.) She was also active in the formation of UNICEF, and in 1947 she traveled on behalf of UNICEF to central and eastern Europe to conduct a study of how best to address the needs of children in war-torn countries. From 1949 to 1951, Eliot worked as an assistant director for WHO in Geneva, where she played a major role not only in setting up the organization but in getting governments all over the world to strengthen their health services, especially with regard to children.

Almost needless to say, Martha did not go to Geneva without Ethel, who became a consultant to WHO’s maternal and child health division. In that capacity she developed international interest in training personnel for work with “premies” and in doing research on the connections between socioeconomic problems and premature birth. In 1951, when President Truman named Martha Eliot chief of the Children’s Bureau, the couple returned to Washington together, and Ethel began a long-term study on gestation and parturition.

 

What an “Unnatural Female Celibate” Might Do

Despite the contributions of women such as Martha Eliot and Ethel Dunham to the welfare of American children, they—and the few women like them who flourished as professionals during these years—were often under attack because they didn’t tend to their knitting. For example, arguing against the continued existence of the Children’s Bureau, James Reed, a senator from Missouri, called the women who worked for the bureau (many of whom were lesbians) “unnatural . . . female celibates.” He scoffed that “it seems to be the established doctrine of the bureau that the only people caring for babies and mothers of babies are ladies who have never had babies.” He missed the point that during his era, the ladies who had the babies were convinced that they must eschew a professional life. The senator claimed to believe that instead of having a Children’s Bureau, America would be better off having a “Mothers’ Committee . . . to take charge of the old maids and teach them how to acquire a husband and have babies of their own.” Such attacks must have been hurtful not only to Eliot and Dunham but to any young women who wanted a career rather than a life of “normal” domesticity.

However, Martha May Eliot proceeded as though she were deaf to such criticisms. Her contributions went beyond the welfare of children. For example, in the 1930s she was invited often to Harvard University to lecture on child health, though Harvard had refused to accept her as a medical student in 1914 because she was a woman. Women were admitted to Harvard’s School of Public Health by the 1930s, but they were not permitted to take a degree. The protest and pressure that Eliot exerted on the school made it relent and agree to give women degrees in public health. Harvard even awarded degrees retroactively to women who had completed the program before 1936.

Eliot’s influence in the field of public health was manifested in other ways too. For example, in 1947 she became the first female president of the American Public Health Association. She was also the second female president of the American Pediatric Association—the first was Ethel Dunham—and from 1949 to 1950 she was president of the National Council of Social Work (later called the National Council on Social Welfare). Martha Eliot had by then certainly fulfilled her youthful ambition to “be some kind of a ‘social doctor.’”

Her association with Harvard continued, and in 1957, at the age of sixty-six, she left the Children’s Bureau in order to become one of the handful of women with full professorial status at Harvard, accepting an appointment as professor and head of the department of maternal and child health at the School of Public Health. Ethel, who was then seventy-four years old, moved to Cambridge with her and continued her research on gestation and parturition.

When Martha Eliot retired from her professorship, she was replaced by a man, Dr. William Schmidt. By then the tail end of the generations of women with enough stature to assume such posts—to carry on—had ostensibly long since disappeared. But though Martha was seventy years old, she had not finished working. In 1960 and 1961 she took two major trips to Africa, India, and the Far East to investigate projects that the World Health Organization was financing in developing countries.

Ethel, now on the far side of her seventies, kept the home fires burning. They exchanged almost daily letters during Martha’s travels for WHO. Those letters, written when they were both old women, reveal that the relationship had kept working for them their entire adult lives. Emotionally, they ended much as they began. Ethel encouraged Martha in her WHO work and was excited with her about her travels. Nevertheless, it was still painful for them to be without each other. They wrote day after day: “Dearest, It was hard to say goodbye and I shall miss you terribly. . . . Ever and ever so much love, my darling”; “How I count the time until you do arrive. I miss you my darling”; “I do want you too. . . . I miss you so very much my dearest love.”

 

Martha Eliot began depositing her papers in the Schlesinger Library in 1969, the year Ethel died, and continued until 1976, two years before her own death. In the beginning she culled them. She destroyed most of the letters between herself and Ethel, though she preserved her voluminous letters to her family, which recorded her medical education and early career. (It is fortunate that she preserved those letters, since they provide the best lens we have through which to view the relationship between the two women.) She also began to expurgate the greetings and closings of her letters to Ethel from the 1940s, written when she was traveling for WHO. However, she stopped those expurgations after mutilating only two of the letters, because she saw that the scissors were also destroying important details about WHO, which she thought posterity would be interested in. From the intact letters to Ethel from this period, we can see that she opened with greetings as tame but telling as “Dearest,” which would suggest that by the time she was ready to begin to hand her papers over to the library, people like Senator Reed had made her well aware of homophobia and fearful that even addressing another woman as “Dearest” would be damning.

Martha’s and Ethel’s letters written in 1960 and 1961, including those quoted above, did not suffer from the scissors—although in the face of Martha’s other bowdlerizations, it is not entirely clear why. Perhaps she thought that women in their seventies would never be suspected of having been or being in love with each other. Perhaps by the time she got to those letters, she had decided to let the future make of her and Ethel what it would. Or perhaps Martha Eliot took hope from the lesbian and gay rights movement that emerged in 1969 and grew strong in the 1970s. Perhaps she felt that a generation to come would understand and appreciate what was hinted at in those letters to the woman who had been so central in her life.