Sexual Dysfunction as "The National Disease of America:" Neurasthenia and Medical Approaches to Men's Sexual and Emotional Health in the Gilded Age

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Sexual Dysfunction as "The National Disease of America:" Neurasthenia and Medical Approaches to Men's Sexual and Emotional Health in the Gilded Age
Szymanski, Mallory R
University of Florida
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This dissertation bridges three distinct fields within history: medicine, gender, and sexuality. In 1894, McClure's magazine declared neurasthenia "the national disease of America." In the late-nineteenth century, white neurasthenic men, across classes, shared a collective experience of fatigue and sexual anxiety that threatened their gendered self-perceptions. They learned to identify themselves as neurasthenic from ubiquitous cultural information available: newspapers, advertisements, the YMCA, and lay medical literature. Neurasthenia rhetoric defined manhood in terms of potential, it provided a framework for absolution of past moral failures (such as illicit sex or alcohol use), and it affirmed whiteness as a permanent marker of biological superiority that could not be dismantled at the sign of neurasthenic breakdown. Blending cultural and medical history methods, this project argues neurasthenia rhetoric normalized manly weakness as an unfortunate, yet legitimate experience for the most hard-working and civilized men. In other words, it circumscribed racialized and classed boundaries to include white men, however broken, sexually challenged, or emotionally fraught. Patients and doctors utilized this language in the clinic, and as a result, they legitimized otherwise illicit questions about what it meant to be a healthy, empowered, modern white man in an ever-changing modern world.

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2017 Mallory R. Szymanski


To my dad


4 ACKNOWLEDGMENTS I am inde bted to many people who have challenged my intellect and sustained my spirit while I completed my doctorate. Thank you to Benjamin Wise, my dissertation advisor, whose graceful guidance offered me space to make and learn from my mistakes He prompted me to grapple with my work rather than let it grapple with me and he never lost hope that I would figure out that history happened in the past. Dr. W ise taught me that the best history writing comes from somewhere other than the intellect that one must fin d a way to love their way into the process to produce truly compelling work. I thank my dissertation committee members, Steve Noll, Sheryl Kroen, and Elizabeth Dale for offering feedback and support throughout this long p rocess Thanks to Louise Newman, who encouraged me to believe good teachers can also be good academics. And to Dave Tegeder who provided reliable employment at Santa Fe College and a sympathetic ear along the way. The support I have received at the Center for Gender, Sexualities, and W has provided important stability and mentorship. Bonnie Moradi offered carefully considered feedback and advice about professionalization. Donna Tuckey made sure I always felt included as a valued member of the Center, and brought laughter and light every day. To Trysh Travis, who has mentored me since the sec ond Bush administration, I owe enduring gratitude. Trysh tells me the tru th boldly, persistently and though it took me a while to realize this, I understand this as a sign of genuin e respect. I am indebted to Trysh for modeling this rare form of candid friendship. Through her example, I find I am able to take myself seriously as a scholar wit hout sacrificing true humility or a raucous sense of humor. My research in Philadelph ia succeeded primarily because Brie Von Hausch gave me a cozy home base from which to explore the archives. Beth Lander at the College of Physicians


5 as an enga gement with gender identity. Michael Angelo from Jefferson Medical School ensured a long day of archival research involved laughter and brevity. I am grateful for research travel support from the College of Physicians and the University of Florida D epar t ment of H istory My fellow graduate student friends have protected my sanity and nurtured my project in crucial ways. I am grateful to Carrie Streeter, whose prompting opened my eyes to the YMCA collections in Minneapolis, and whose conversations over che ese and wine reminded me how to find the glitter in the dusty pages of the archives. My dissertation writing group motivated me to keep working through blocks a nd triumphs. I appreciate the many hours Michael Gen n aro, Andrew Welton, Johanna Mellis, Elyss a Gage, Alana Lord, Kerri Blumenthal and Jessica Taylor spent reading and talking over drafts of this dissertation. Without the insistent presence of Lewis Kirvan, I may have not made it through coursework, and I a m still amazed I wrote a dissertation aft er he moved far away My dear friends and family have supported this project with their generous helpings of encouragement, time, and love To Emily Eckhardt, Todd Palmer, Shannon Williams, the Spooky Crew, Lee Whittier, Yoshimi Kaga, Jasmine Tran, Dave Piasecki Aunt Nini, Aaron Benneian, Dave Jerse, Maureen Killoran, and Zoharah Simmons: thank you for lifting me up through your friendship, time, and encouragement. To my mom and Mikey, for being proud of me, and for letting me know that Dad would be pro ud of me, too. To the memory of my dear old Dad, which inspires me to do the hard work of seeing the bright side in all things And most of all, to Lem, whose unwavering faith in me ameliorates the valleys of self doubt. I survived even enjoyed graduate school because of his steadfastness and his power of positivity Lem is the icing and the cake.


6 TABLE OF CONTENTS page ACKNOWLEDGMENTS ................................ ................................ ................................ ............... 4 ABSTRACT ................................ ................................ ................................ ................................ ..... 8 CHAPTER 1 INTRODUCTION ................................ ................................ ................................ ....................... 9 2 DIMENSIONS OF NERVOUS ILLNESS AND SEXUALITY IN THE GILDED AGE .... 21 Introduction ................................ ................................ ................................ ............................. 21 Neurasthenia: the common illness for the every (white) man ................................ ................ 23 Sexual Neurasthenia ................................ ................................ ................................ ............... 44 3 LAY MEDICAL LITERATURE: IDENTIFYING AND TREATING THE NEURASTHENIC MAN ................................ ................................ ................................ ....... 50 Introduction ................................ ................................ ................................ ............................. 50 Medical Training and Early Career of S. Weir Mitchell ................................ ........................ 55 ...................... 67 1880s: Growing Visibility of Nervous Men ................................ ................................ ........... 73 Conclusion ................................ ................................ ................................ .............................. 91 4 M THE YMCA ABOUT SEXUAL HEALTH 1879 1900 ................................ ................................ 94 Introduction ................................ ................................ ................................ ............................. 94 Comstock Anti Vice and early YMCA Medical Talks ................................ .......................... 97 The Rise of the Nervous Bureaucracy: The New York Branch of the YMCA .................... 101 ................................ ................................ ................................ ........ 111 Contaminating the Minds and Health of Men ................................ ................................ ...... 120 Dangerous Behavior and its Victims ................................ ................................ .................... 123 Neurasthenia as a National Emergency ................................ ................................ ................ 129 The Role of the Physician ................................ ................................ ................................ ..... 132 5 AND NEURASTHENIA ................................ ................................ ................................ ...... 142 Introduction ................................ ................................ ................................ ........................... 1 42 Neurasthenic Breakdown in the National News ................................ ................................ ... 145 Sex and Scandal in The National Police Gazette ................................ ................................ 165 Doctors Making News ................................ ................................ ................................ .......... 180 Conclusion ................................ ................................ ................................ ............................ 184


7 6 MEDICAL ABSOLUTION: CONSTRUCTING AND TREATING SEXUAL AND EMOTIONAL HEALTH PROBLEMS IN THE CLINIC ................................ ................... 186 Introduction ................................ ................................ ................................ ........................... 186 The Philadelphia Infirmary for Nervous Diseases: Men Who Sought Treatment from the Philadelphia Infirmary of Nervous Diseases, 1880s and 1890s ................................ .. 189 The Informed Neurasth enic Patient ................................ ................................ ...................... 200 ................................ ................................ .................... 206 ................................ ................................ ... 213 ................................ ............................ 226 7 CONCLUSIONS ................................ ................................ ................................ ...................... 236 LIST OF RE FERENCES ................................ ................................ ................................ ............. 243 Primary Sources ................................ ................................ ................................ .................... 243 Secondary Sources ................................ ................................ ................................ ................ 244 BIOGRAPHI CAL SKETCH ................................ ................................ ................................ ....... 254


8 Abstract of Dissertation Presented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosop hy EMOTIONAL HEALTH IN THE GILDED AGE By Mallory R. Szymanski May 2017 Chair: Benjamin Wise Major: History In 1894, magazine decl In the late nineteenth century, white neurasthenic men, across classes, shared a collective experience of fatigue and sexual anxiety that threatened their gendered self perceptions. They learned to iden tify themselves as neurasthenic from ubiquitous cultural information available in newspapers, advertisements, the YMCA, and lay medical literature. Neurasthenia rhetoric defined manhood in terms of potential, it provided a framework for absolution of past moral failures (such as illicit sex or alcohol use), and it affirmed whiteness as a permanent marker of biological superiority that could not be dismantled at the sign of neurasthenic breakdown. Blending cultural and medical history methods, this project argues neurasthenia rhetoric normalized manly weakness as an unfortunate, yet legitimate experience for the most hard working and civilized men. In other words, it circumscribed racialized and classed boundaries to include white men, however broken, sex ually challenged, or emotionally fraught. Patients and doctors utilized this language in the clinic, and as a result, they legitimize d otherwise illicit questions about what it meant to be a healthy, empowered, modern white man in an ever changing modern world.


9 C HAPTER 1 INTRODUCTION In 1894 s M agazine pronounced neurasthenia t America. 1 It silently crept up on ordinary people who struggled to cope with a rapidly urbanizing society. Often the result of overwork or over excitement, neurasthenia drained Americans of their verve. Hours of intense thinking sapped the intellectual stamina of philosophers and scientists Mechanization attenuated the professional pride of blue collar work. For men specifically, the tenets of manhood shift ed rapidly during the Gilded Age. Because of these pressures, neurasthenics presented various symptoms: s ome grew listles s and withdrew from public life; o thers manifested physical symptoms su ch as indigestion and headache; s ome expressed cri ppling anxiety and fear that poor life choices caused their illness Many cases involved a confluence of symptoms like these or later, nervous illness. 2 As Magazine noted, other doctors, like S. Weir Mitchell, President of the Medical Society of Pennsylvania, also felt a sense of national urgency. Best known for his treatment of Charlotte Perkins Gilman, Mitchell founded the first and only clinic for nervous malady of the Americ 3 undergirded neurasthenia in the late nineteenth century. Doctors in the U.S. believed climate, 1 1894: 302. 2 Ibid. 3 Ibid., 305.


10 environment, and long working hours made Americans uniquely prone to the disease. T he dominant view, described by held that those with higher ethnic, intellectual, and racial constitutions were more likely to develop neurasthenia. Unlike insanity, a lifetime diagnosis, neurasthenia came and went. As a result, the neurasthen ic avoided any stigma typically associated with mental illness at the time. 4 With proper behavior and medical care, a neurasthenic could transcend his nervous illness and regain optimal health. One aspect of th is afflicted only men; it involved sexual concerns such as impotence, sexual performance, and fears about masturbation. Dr. Beard called it sexual neurasthenia one of several subcategories of general neurasthenia Characterized by a ignored contingent of nervous men. 5 Other symptoms included disdain for sex, involuntary emissions, and debilitating worry. Beard wrote in his posthumously published book, Sexual Neurasthenia, a nd finely organized lads of our cities and of the higher civilization are overcome by a higher 6 Only white men suffered from neurasthenia, and he believed the hard labor of working class men shielded them from nervous illness. 7 Sexual dysfunctions among 4 Care for the insane lay at the center of political, economic, and medical debat es in the second half of the nineteenth century. More mentally ill young adult patients, unable to work and support themselves, became wards of the state in asylum care. Furthermore, a growing population of the elderly without financial support wound up in asylums. A person suffering from some of the mental health ailments common to neurasthenia had a stake in avoiding the stigma associated with insanity diagnoses. This may be why these patients went to hospitals rather than psychiatric wards for assist ance. For more on the diagnosis and treatment of insane patients at the end of the nineteenth century, see Gerald N. Grob, The Mad Among Us: A History of the Care of America's Mentally Ill (New York: Free Press, 1994), especially chapter three and four. 5 George M. Beard, Sexual Neurasthenia (Nervous Exhaustion) Its Hygiene, Causes, Symptoms, and Treatment, With a Chapter on Diet for the Nervous (New York: Arno Press, 1884, 1972): 45. 6 Ibid. 102. 7 This point generates contention among historians, a nd it will be unpacked in the next chapter.


11 thoroughly depress the patient and take from h im all hope and ambition than this, and in no class where the symptoms are so distressing and persistent as in sexual neurasthenia are we so sure of 8 existing discourse of neurasthenia to talk with men about sexual and emotional health. This dissertation examines the ways sexual neurasthenia performed cultural and medical functions in the late nineteenth century to help men resolve problems regarding sexual des ire, erectile health masturbation, and marital satisfaction. Several factors contributed to the nervous decline of men in the Gilded Age. In general, rapid urbanization and industrialization reorganized racial and gendered social orders in profound way s. First, white women applied the small but growing body of scientific information to refute Social Darwinist notions that male brains were functionally superior to female brains. They called for suffrage, access to fair employment, and legal power over their earnings, property, and bodies. They pushed back against marriage laws that as the 1848 Declaration of vis her husband. 9 At the same time, native born white men witness ed Black people and immigrants dilute labor pools for jobs they felt entitled to hold As wages fell and cities swelled with fresh waves of workers, many men found it increasingly difficult to secure gainful employment. It seemed, in this moment of social, economic, and technological flux, the gendered and racial order transformed as well and this made men very nervous. 8 Beard, Sexual Neurasthenia 298. 9 Elizabeth C. Stanton, Declaration of Sentiments ( Gray, Beardsley, Spear and Co, 1854).


12 Pressure came not only from the outside from white women and immigrants -but also within groups of men themselves. The sexual neurasthenic was one in a pool of popular and seductive ideals presented to Gilded Age men, especially in cities. Conventional American on involvement of active fatherhood. 10 Body builders boasted a Greek ideal of a muscular physique. 11 Boxers demonstrated a competitive, burly edge. Saloons and gambling houses plied men with drink and sexual opportunities. 12 Of course, some men managed to attain these manly ideals, but most fell short Ins tead, they struggled with long work hours, nagging marital obligations, and persistent financial strain. One Washington Post his desire t o get rich, the worry of his business or profession, or his aspirations for Social or 13 This is why neurasthenia sexual neurasthenia, and their pseudonyms, found such a wide and receptive audience they identified a common source of pres sure, and through medical treatment, offered some relief 14 10 Anthony Rotundo, American Manhood: Transformations in Masculinity from the Revolution to the Modern Era (New York: Basic Books, 1993). 11 Kasson, John F. Houdini, Tarzan, and the Perfect Man: The White Male Body and the Challenge of Modernity in America. (New York: Hill and Wang, 2001). 12 Howard P Chudacoff, The Age of the Bachelor: Creatin g an American Subculture (Princeton, N.J.: Princeton University Press, 1999). 13 Display Ad 15. Washington Post (Washington D.C.), June 14, 1894. 14 While George Beard emphasized sexual neurasthenia as a discreet medical diagnosis of paramount importance, will show, doctors did not readily distinguish sexual neurasthenia from its general forms. In popular culture and medical books written for pu blic audiences, the language of sexual neurasthenia took on many euphemisms. Henceforth, this dissertation will mark a distinction between sexual neurasthenia and general neurasthenia when it is relevant. Otherwise, the findings will show that in practic dysfunctions, blurring a necessary distinction between the two.


13 As this dissertation will show, sexual components of neurasthenia recast sexual debility in terms of the potential to reclaim manly power. Furthermore, the medical framework neutralized the mora l charge of sexuality and provided a language through which men could articulate their intimate concerns. Finally, diagnosis and treatment of neurasthenia served as a scapegoat for all sorts of weaknesses, thereby relieving the pressure to disavow weaknes s entirely. I argue that the cultural and medical significance of neurasthenia lay in its ability to allow the prototypical neurasthenic man to acknowledge his sexual and emotional weaknesses without ceding his sense of his manhood. sexual symptoms men faced and its impact was significant. 15 Cultural historian Brad Campbell 16 Campbell sees neurasthenia as an agent of American modernity, a model for inhabiting the paradox of modern life. David and its emphasis on rest as a curative function introduced leisure as an appropriate antidote to the Protestant work ethic. 17 Heart of Whiteness, addresses the central role neurasthenia played in fastening race, gender, and 15 My argument that neurasthenia normalized some aspects of sexuality, or at the very least, discussion of sexuality, relies on Eliza laid new conceptual foundations for their specialty, delineating a realm of everyday concerns sex, marriage, womanhood, and manhood; work, ambition, w orldly failure; habits, desires, inclinations as properly the neurasthenia diagnosis. See Elizabeth Lunbeck, The Psychiatric Persuasion: Know ledge, Gender, and Power in Modern America ( Princeton, NJ: Princeton University Press, 1994): 3. 16 History of Psychiatry 18, (2): 164. 17 David G. Schuster. Neu 1920. (New Brunswick, NJ: Rutgers University Press, 2011).


14 sexual anxieties together in the la te nineteenth century. 18 Other cultural historians concur that the greatest value of neurasthenia lay in the cultural work it performed. 19 This dissertation adds to the cultural histories about neurasthenia to show that the sexual dimensions of the disease figured more prominently than previously thought. T his work locates neurasthenia rhetoric facing medical literature. It shows that for men, neurasthenia rhetoric connoted messages about anxiety, sexual dysfunction, and ultimately -absolution. Doctors reaped some benefits from this neurasthenia epidemic, too. The three pages of symptoms left diagnosis and treatment open to the interpretation of the physician. Furthermore, treatments varied wid ely, including rest, coitus, electric shock, water cures, and most commonly, various elixirs and sedatives. 20 trained perspective. The pervasive use of neurasthenia as a catch all diagnosis pot entially expanded the reach of the physician in the Gilded Age. Individual doctors often took responsibility for educating and attracting patients. The broader medical profession, still assembling the tenets of the American Medical Association was (found ed in 1847), did not formalize medical education standards until the early twentieth century. 21 Therefore, in the era of neurasthenia (1880s and 1890s), a thin line separated legitimate medical professionals from 18 Julian Carter. The Heart of Whiteness: Normal Sexuality and Race in America, 1880 1940 (Durham: Duke University Press, 2007). 19 See Tom Lutz, American Nervousness, 1903: An Anecdotal History (Ithaca, NY: Cornell University Press, 1991) ; Marjike Gijswijt Hofstra and Roy Porter, eds. Cultures of Neurasthenia From Beard to the First World War (New York: Rodopi, Inc., 200 1). The historiographic debate about neurasthenia will be addressed in further detail in Chapter Two. 20 Beard explains the value of each in detail. See Beard, Sexual Neurasthenia, 207 246. 21 Charles Donald O'Malley, The History of Medical Education; An I nternational Symposium Held February 5 9, 1968 (Berkeley: University of California Press, 1970): 507 510.


15 quack doctors preying on the uninformed. E ven some well respected physicians initially rejected neurasthenia, calling it too vague to be effective. Nonetheless, Beard and Mitchell, and their constituents set a standard for neurasthenia diagnosis and treatment. Charles Rosenberg argues that neuras national reputation in the late nineteenth century 22 Medical historians remain skeptical about ways diagnostic categories granted physicians unequiv ocal power that benefited the practitioners as much as, if not more than the patients they treated. 23 While certainly, the careers and pocketbooks of George Beard and S. Weir Mitchell benefitted from promoting neurasthenia, I believe these doctors also ris ked a lot. Both men drew from their own bouts with neurasthenia to promote awareness of the disease; in doing so, they exposed themselves as weak and nervous. They projected themselves as vulnerable compatriots of neura sthenic Americans who extended a sy mpathetic ear (that also came with medical expertise) from on e man to another. T his dissertation reads physicians as a necessary part of the story of emotional element s and the way these discourses came to bear on individual men in the clinic. 24 Doctors who treated neurasthenic men al so risked a ffiliating themselves with sexuality Still associated with prurience and quackery, medical discussions of sexuality threat ened to 22 Charles Rosenberg, No Other Gods: On Science and American Social Thought. (Baltimore, MD: Johns Hopkins University Press, 1976): 98. 23 Interestin reputation. See Rosenberg, No Other Gods, 98. Another notable example of this includes Harry Stack Sullivan who treated homosexual patients in the mid twentie th century. Wake, Naoko, Private Practices: Harry Stack Sullivan, the Science of Homosexuality, and American Liberalism. New Brunswick, NJ: Rutgers University Press, 2011). Also, physicians usurped the position of midwives by centralizing abortions in ho spitals in the nineteenth century. See Leslie J. Reagan, When Abortion Was a Crime: Women, Medicine, and Law in the United States, 1867 1973 (Berkeley: University of California Press, 1997). 24 Certainly, further research is needed on the degree to which physicians used neurasthenia as a conduit for professionalization.


16 25 In addition the public viewed doctors with general suspicion, and patients felt reluctant to trust doctors with private matters E ven the best trained, most successful doctors, like Dr s George Beard and S. Wei r Mitchell engaged in ongoing labor to prove their le gitimacy to skeptical patients their livelihood depended on it. 26 So, when Dr. Beard declared sexual neurasthenia the most pressing important health concern among men in the 1880s, his fellow physician s initially balked. Beard worked until the end of his life in 1883 to persuade doctors to include in ordinary medical practice After led the profession in treatment of sexual neurasthenia. He influe nced the curriculum at the College of Physicians and trained medical students in his Infirmary for Nervous Diseases in Philadelphia. He instructed his colleagues to counsel with sympathy, and he modeled a safe and nurturing doctor patient relationship to the public. Together, Beard and Mitchell led the emerging field of emerging neurologists in the Gilded Age ; they effectively this period 27 This dissertation argues that the rhetoric of neurasthenia supplied doctors and patients with a useful language to articulate the physical, emotional, and sexual breakdowns men experienced T he rhetoric of n eurasthenia also removed individual responsibility and instead, 25 Sexual Knowledge, Sexual Science: The History of Attitudes to Sexuality eds. Roy Porter and Press, 1994): 284 302. For more on sexologists, who pioneered studies on sexualities, see Lucy Blan d and Laura L. Doan, Sexology in Culture: Labelling Bodies and Desires (Chicago: University of Chicago Press, 1998), especially part I. 26 Chapter Three discusses some of the difficulties Mitchell faced attracting patients to his home clinic, and later ga rnering support for his rest cure. 27 The Freud Encyclopedia: Theory, Therapy, and Culture ed. Edward Erwin (New York: Routledge, 2002): 364.


17 indicted American modernity T his dissertation will show that men used medical language about neurasthenia to describe themselves as weak and broken and they invoke d that same rhetoric to conceive of themselves as powerful, educated, elite American men. Therefore, this dissertation intervenes in the historiography about masculinity, medicine, and neurasthenia in the lat e nineteenth century. Chapter t onal Disease of America: engages each of these fields to explains the circumstances under which the disease, and its corollaries rose in popularity in the 1880s and 1890s. Neurasthenia first appeared in American medical literature in 1869 and fell out of favor by World War I when shellshock came to name similar trauma induced symptoms. However, the mind body approach to sexual neurasthenia was only commonly used in the 1880s and 1890s. Standing as a bridge between Christian morality, which governed earlier modes of sexual instruction, and Freudian psychoanalytical approaches at the beginning of the 20 th century, sexual neurasthenia provided a framework for men to e Despite the availability of quack remedies and for profit cures, the public in the Gilded Age had access to more medical information written by physicians than ever before. T o educate the public about the obscure yet quotidian nature of nervous disease, leading neurologist S. Weir demonstrates how pub lic facing medical literature instructed men about their health, and encouraged them to see their frailty, emotional distress, and sexual anxiety as a medical problem rather than a moral one. This chapter looks specifically at ical writing about nervousness and the rest cure H istorians often and I argue this has caused them to m iss the


18 valuable instruction he provided to men. In this chapter, I argue Mitchell normalize d the neurast henic experience for men. Perhaps more importantly, he present ed the physician as a trustworthy confessor for all past indiscretions In a different way than other sources, the lay medical literature presents the figure of the physician as a counselor or mollifier --who, by but caused it to disappear. sly than the YMCA. In chapter four about Sexual Health 1879 I argue the YMCA promoted a Christian camaraderie among men as a tool of resistance to sinful behavior In an effort to refashion itself as a modern institution after the Civil War, individual Y MCA branches embroiled themselves in the battle against urban vice; this included providing medical education to crowds of young men. This chapter shows that the flagship branch, the New York Association, led by General Secretary Robert McBurney, hosted m any only medical talks Led by physicians and sometimes teamed with pastors, these talks relied heavily on neurasthenia rhetoric. A united front, Christian and medical leaders taught New York men of working and middle classes that sexual desire wa s normal, that sexual ruin was imminent and could happen to anyone, and that those who suffer from sexual dysfunctions were victims of their environment. The broader culture of sexual neurasthenia echoed in the Association halls as hundreds of young men g athered to learn about how to have a happy, healthy life as a young white man. O utside formal medical lectures information about sexual neurasthenia could be found almost everywhere especially in news stories and advertisements. T he popular media ofte n described sexual neurasthenia in terms of lack a tragic loss of vitality among men. Chapter five


19 shows how media inundated men with intimidating news about the frailty of For example, The Associated Press circulated news articles about nervous men and sexual debility to local papers across the country. In saloons and gambling halls, copies of the Police Gazette lay strewn about ; these included a dvertisements about remedies for low libido or erectile trouble. These messages worked. Men sacrificed large portions of their salaries to purchase these cures by mail Others attended traveling medical shows that convinced men to recognize themselves as sexually vu lnerable, and then sold them the remedy on the way out. While these sources appealed to a different audience than the YMCA and yielded less medical authority than credentialed physicians did their messages were the same: men feared their bodies and their sexual futures were breaking down, and they wanted help. All of these messages about sexual health and nervousness drove anxious men into the the 1880s and 1890s. Chapter six Medical Absolution: Constructing and Treating Sexual a draws from patient records from mirrored the cultural ones: in the clinic, men disclosed fears of inadequacy and sex ual deviance to their physician, and these resembled the rhetoric in news, YMCA, and lay medical literature. This chapter argues that men came to the clinic already armed with information about neurasthenia, and sought s ympathetic care for their illness. Most notably, men complained to their doctors about the crippling worry they encountered worry that their childhood masturbation habits or their illicit affairs with women induced sexual dysfunction later in life. Patient records show remarkable inconsis tency in the difference between sexual and non sexual cases; I conclude that sexual concerns permeated the broad category of neurasthenia for men. Additionally, doctors proscribed a wide array of treatments to patients. I argue the most


20 effective remedy for neurasthenia was the medical absolution the physician offered. Trained to be sympathetic and non judgmental, physicians transformed the clinical space into a safe environment for men to admit and process their feelings of inadequacy. Ultimately, whe n the physician labeled a man with some form of nervous illness, he also absolved him of responsibility and promised him he could be healthy again. This worked men who had suffered for years with distressing symptoms rarely needed more than one visit with Dr. Mitchell to return to health. As a whole, this dissertation positions sexual neurasthenia as an important link between Victorian sex negativity and the Freudian belief that sexual desire motivated every human impulse. It shows how a fledgling medi cal profession struggled to provide concrete answers to complex modern medical questions and how physicians employed neurasthenia to successfully address a range of desperate, panicked patients. More importantly, this dissertation shows the power of scie ntific authority or even just the semblance of such, as in the case of quack doctors and medicine shows to circumscribe normal, healthy sexual behavior. In this case, the sexual neurasthenic could be any and every white man in America He could see himsel f as biologically superior and more civilized than women or racial minorities, or intellectually fatigued and functionally inept. He could be a productive married head of household, or a bachelor who delighted in the company of men. He could be a portra it of Christian chastity, or a chronic masturbator; over stimulated or listless; hypersexual or completely uninterested in sex. Thoug h the sexual neurasthenic potentially embodied many coexisting contradictions, he could never be a woman, and he was alway s white. Thus, the ubiquity of the cultural and medical attention to sexual neurasthenia in the late 19 th century flattened class differences and provided an attainable and affirming manly ideal that reified racial and gender hierarchies as essential.


21 C HAPTER 2 T HISTORIANS AND THE GENDERED DIMENSIONS OF NERVOUS ILLNESS AND SEXUALITY IN THE GILDED AGE Introduction Dr. George Beard in hi s New York office in 1883. The patient complained that heightened sexual arousal tended to result in weakness in his eyes. Beard called him Case XXXII and described him as a 36 year old white man who was well educated in the sciences. The patient report ed regular sexual activity with a woman, but he worried his present dysfunctional condition rendered him unfit for marriage. Diagnosing him with sexual n eurasthenia, Beard advised the patient hening treatment, continue for a number of months. W hen he regained his sexual and nervous strength, Bear d felt he would be ready for marriage. 1 The treatment proved successful. In his posh New York Clinic, Dr. Beard counseled man y men who disclosed similar intimate fears and sexual uncertainty Known as the father of neurasthenia, Beard leveraged his professional authority to raise awareness about the debilitating anxiety male patients experienced. 2 He educated physicians abou t sexual neurasthenia at conferences and in medical journals He wrote a monograph entitled Sexual Neurasthenia to publicize the severity of this commonplace medical practi ce, concerned the conservative public might dismiss them as prurient quacks. popular and well accepted in the Gilded Age: the so 1 George Beard, Sexual Neurasthenia: Its Hygiene, Causes, Symptoms, and Treatment, 5e. (New York: E.B. Treat and Company, 1898): 187. 2 The Boston Medical and Surgical Journal, (1869): 217 221. Beard is credited for first publicizing the disorder in the U.S. in this 1869 publication.


22 neurasthenia. Neurasthenia broadly described ailments such as fatigue, headache, indigestion, and nervousness. The diagnosis carried no social stigma; in fact, Beard believed it signaled intellectual acuity and exceptional civility he even dubbed it Ame rican Nervousness to magnify the exceptionalism associated with the disease. 3 Yet when doctors re fused to acknowledge the sexual symptoms so many men faced, Beard believed their silence actually exacerbated the problem. Beard instructed his colleagues to listen sympathetically to their to take careful note of their habits and histories, and to assess the unique experience of each patient. Many doctors had already mastered the treatment of neurasthenia, so the framework for integ rating sexual health was prime. As a result, sexual neurasthenia became an important medical diagnosis for men in the late 19 th century. However, historians neglect the significance of sexuality in the vibrant debates about neurasthenia. They often dis miss it as an incidental subcategory among a litany of descriptions, control. Despite the fact that Beard believed sexual neurasthenia constituted a medical crisis among me n, historians regard it as ancillary. This dissertation moves sexuality to the center of the history of neurasthenia, and argues that men embraced the label of neurasthenia because it permitted them to acknowledge, articulate, and move on from traumatic, often debilitating sexual concerns. A unique discursive icon in the Gilded Age, sexual neurasthenia gave men an outlet to discuss the 3 Certainly, neurasthenia existed in Europe in the nineteenth century, also. In fact, until the end of the century, most doctors who sought formal medical training went to Europe. However, American physicians and neurologists viewed neurast henia through the lens of American exceptionalism. For more on the European treatment of neurasthenia see: Bakker, Nelleke. "Before Ritalin: Children and Neurasthenia in the Netherlands." Paedagogica Historica 46, no. 3 (2010): 383 401; Andreas Killen, B erlin Electropolis: Shock, Nerves, and German Modernity ( University of California Press, Berkeley, 2006).; Kristine Lillestl, and Hilde Bondevik. "Neurasthenia in Norway 1880 1920." Tidsskrift for den Norske lgeforening : tidsskrift for praktisk medicin, ny rkke 133, no. 6 (2013): Century Russia." Medical History 47, no. 1 (2003): 23 46.


23 inadmissible. This chapter will discuss the significant scholarly debates around neurasthenia into which this project in tercedes: nervous illness in the Gilded Age, the gendered tensions bound up in industrialized life, changing sexual mores, the connection between manhood and whiteness, and the role of the physician in diagnosis and treatment of nervous illness. This diss ertation argues that neurasthenia served important cultural and medical roles. Men internalized the cultural rhetoric about sexual debility and nervous illness; yet this same rhetoric helped men refashion identities to include sexual uncertainty, masturba tion, and dysfunction as part of healthy, white American manhood in the Gilded Age. Neurasthenia: the common illness for the every (white) man health, Dr. George Beard first published about neurasthenia in the Boston Medical and Surgical Journal 4 Widely regarded as the father of neurasthenia, Beard dedicated the final decades of his life and career to raising awareness about this disease among medical and lay audiences alike. He wrote two monographs on the subject: A Practical Treatise on Nervous Exhaustion (Neurasthenia) in 1880 and American Nervousness: Its Causes and Consequences in 1881. These books educated doctors and potential patients about the various manife stations of this disease. Beard detailed an exhaustive two page list of symptoms of nervous disease. 5 These included some physical symptoms: back pain, skin dryness, heaviness, ticklishness, and indigestion; others involved mental and emotional facultie 4 While Beard was not the first to coin the term, he popularized i t. In fact, Edwin H. Van Deusen had also published Boston Medical and Surgical Journal 3 (April 29, 1869): 217 222. 5 George M. Beard, American Nervousness: Its Causes and Consequences (New York, NY: G.P. Putnam's Sons, 1881): 7 8.


24 6 The majority of the symptoms could relate to any everyday experience. As neurasthenia grew in popularity in the 1880s and 1890s, quotidia n conditions like fatigue, anxiety, or itching, increasingly became associated with the epidemic of nervous illness. Beard and fellow nerve scientists placed neurasthenia on a spectrum between low level nerve illnesses like sick headache and near sighted ness and the most extreme form of nervousness: insanity. Insanity lay at the center of fierce debates about the etiology of mental illness in the late nineteenth century. 7 Some physicians believed to be an inborn and others ld degenerate at some point. Alienists argued for psychological origins of mental illness, while physicians located empirical evidence in the body to explain disease. 8 A neurologist, George Beard combined psychological and physical perspectives from the two major camps to produce a psychosomatic approach to neurasthenia. Beard wrote in 9 He placed the vast and various symptoms of neurasthen ia squarely on the fence of the mind body debate. 6 Ibid., 8. 7 For a discussion of the role alienists played in Gilded Age society, specifically their role in deciding the mental competence of accused crimin als on trial, see Charles E. Rosenberg, The Trial of the Assassin Guiteau: Psychiatry and Law in the Gilded Age (New York: Notable Trials Library, 1996). 8 For more on this see Lynn Gamwell, and Nancy Tomes. Madness in America: Cultural and Medical Percep tions of Mental Illness Before 1914 Ithaca, N.Y.: Cornell University Press, 1995; Grob, Gerald N. Mental Illness and American Society, 1875 1940 Princeton, N.J.: Princeton University Press, 1983. Rosenberg, Charles E. No Other Gods: On Science and Ameri can Social Thought Baltimore: Johns Hopkins University Press, 1976; Edward Shorter, From Paralysis to Fatigue. A History of Psychosomatic Illness in the Modern Era. New York: The Free Press, 1992. 9 Beard, American Nervousness, 2.


25 Beard blamed modern civilization for scourging Americans with nervous illness in the late nineteenth century. In fact, Beard described neurasthenia as a uniquely American condition, wrought by the conflu ence of climate, technology, and an American work ethic. Beard testified to five components of American experience which contributed to the rise of neurasthenia in the United States: steam power, the periodical press, the telegraph, scientific advancemen 10 The impact of such a fast paced modern society on individual health was clear: nervous women and men suffered anxiety, dyspepsia, depression, and fatigue and many other symptoms. Additionally, the most likely victi m of neurasthenia was the brain worker whose job overtaxed the brain without allowing sufficient physical exercise. Less modern Europeans, Americans in the South, Catholics, Native Americans, and black people, Beard believed, were less likely to develop n eurasthenia. Notable neurasthenics included thinkers, writers, and scientists, the likes of Walt Whitman, Theodore Roosevelt, Jane Addams, and Charlotte Perkins Gilman. Educational materials intended for the public appeared as early as 1871 and they end orsed an affiliation between nervousness and upper class status. In his popular medical text, Wear and Tear, wo rkplaces. 11 As subsequent chapters will show, d escriptions of empowered neurasthenics circulated in popular culture. Beard and his colleagues characterized neurasthenics as part of a white, educated elite class of people whose professional demands cripple d their physical abilities. 10 Ibid., 96. 11 S. Weir Mitchell, Wear and Tear, or Hints for the Overworked


26 Others echoed the belief that neurasthenia affected Americans uniquely. Albert Gray, a 12 William James famously referred to the disease as Americanitis, purportedly as a commentary about his own bout with the disease. 13 The Wall Street Journal and Washington Post In 1906, John Chester of the Evening Star declared that way of life that generates the oppressive disorder of 14 Though European doctors discussed neurasthenia in the nineteenth century as well, historia ns concur that the American version possessed a unique flavor. In an article in the History of Psychiatry, 15 More im portantly, he modern, neurotic subject. 16 To be neurasthenic in the Gilded Age was to be quintessentially American. Many Americans suffered from the disease. I n 1894, heralded 17 A New York Times report warned that so 12 Cimarron News and Cimmaron Citizen, June 18, 1919. 13 Robert D. Richardson, William James: In the Maelstrom of Am erican Modernism: a Biography (Boston: Houghton Mifflin, 2006): 310. 14 Evening star. (Washington, D.C.), 11 March 1906. 15 History of Psychiatry 18, (2): 164. 16 Ibid. 17 1894: 302.


27 18 Media hyped the threat of neurasthenia in educational adver disease, which in these modern, strenuous times is be 19 Together, media messages convinced the American public to view thems elves as potential victims of this common disease. Some physicians in the late nineteenth century balked at the neurasthenia diagnosis, questioning whether it was even a real condition. For example, in a debate among physicians in the American Medical As sociation in 1914, Boston physician, Dr. Walter B. Swift decried the basket something to say in place 20 Over a decade later, Johns Hopkins University physician, Dr. Leonard Hi rschberg published a similar critique in the newspaper. He portrayed the majority of doctors ble to put the blame upon the 21 Even S. Weir Mitchell, infamous promotor of the rest cure for nervousne ss, and the focus of chapter three wrote privately of his disappointment when 18 "Says 'Americanitis' Kills 240,000 Persons here Yearly." New York Times (1923 Current File), Apr 17, 1925. 19 Arizona Republican. Oct. 8, 1909. 20 Journal of the American Medical Association, Vol 63, no 12 (Sept 19, 1914): 1003. 21 Richmond times dispatch. (Richmond, Va.), 30 Jan. 1916.


28 colleagues did not readily appropriate his successful treatment. Between 1869 and World War I, physicians debated the medical l egitimacy of the neurasthenia diagnosis. 22 This debate informs the scholarly treatment of neurasthenia as historians assess the value and impact of the disease in the Gilded Age and the Progressive era. A few points generate consensus: scholars agree that neurasthenia grew in popularity in the 1880s and 1890s due to a cohort of Northeastern elite neurologists, led by George Beard in New York and S. Weir Mitchell in Philadelphia; the disease described an experience that seemed uniquely American; and it mani fested in response to industrial and urbanizing forces that shifted the tenor of American life. Beyond these, several points of contention characterize the historiography on bate about the following questions: What was the significance of neurasthenia? Did women or men have it more? Who fell ill to neurasthenia, and why? Just like physicians worked hard to answer these questions before their skeptical peers and an uniforme d public, scholars frame neurasthenia in different ways. The subsequent overview of the historiography on neurasthenia places this dissertation among a vibrant and ongoing conversation about the historical significance of neurasthenia in the Gilded Age. Furthermore, it demonstrates how this dissertation addresses a gap in the scholarship: including an approach that considers sexual and emotional health in the perceptions. While physicians did quibble over whether neurasthenia was a distinct disease or a 22 neurasthenia but it resulted from traumatic war experience in the tren ches. Shell shocked soldiers granted a new credence to the mental or emotional impact a traumatic event could have on an individual. The atrocity of new war technologies also dramatized the murderous potential lurking within modern life. By the end of W orld War I, many on soldiers, see Paul Fussell. The Great War and Modern Memory (London: Oxford University Press, 1977).


29 Historian Charles Rosenberg argues that the diagnosis constituted a continuation of earlier models of ill health ra ther than a sudden, Gilded 23 Marjike Gijswijt Cultures of Neurasthenia From Beard to the First World War use the plural concept of cultures to promote a cross cultural comparison of neurasthenia in different contexts. This collection shows the value of seeing neurasthenia as an umbrella term, which changed meanings across time and place. In tandem with religious ideas, therapeutics, the mind body problem, gender roles, and technology, the concept of neurasthenia developed differently in Germany, France, The Netherlands, and the United States. Put this way, George Beard was not entirely w rong neurasthenia in the United States was an American disease, responding to unique challenges to labor and gender roles of the time period, and disseminating into a young medical field which scrapped its way to legitimacy by the end of the 19 th century. 24 Thus, neurasthenia happened elsewhere in the nineteenth century; it simply happened differently in the United States. Historians locate the cultural impact of nervous illness in many arenas of Gilded Age America. In American Nervousness, 1903, historia n Tom Lutz argues that a reverberated in the realm s of American leisure, work, economy, and gender. 25 In 23 Charles E. Rosenberg of the History of Medicine, 36, (1964): 245. 24 Marjike Gijswijt Cultures of Neurasthenia From Beard to the First World War (New York: Rodopi, Inc., 2001): 1 30. 25 Lutz, American Nervousness, 23 See also Nancy Cervetti, S. Weir Mitchell 1829 ( University Park, Pa. : Pennsylvania State University Press; Marjike Gijswi jt Hofstra and Roy Porter, eds. Cultures of Neurasthenia from Beard to the First World War (2001); Helen Lefkowitz Horowitz,. Wild Unrest: Charlotte Perkins Gilman and the Making of "The Yellow Wall Paper" (New York: Oxford University Press, 2010 ); David Schuster, Neurasthenic Nation: America's Search for Health, Happiness, and Comfort, 1869 1920 (New Brunswick, N.J.: Rutgers University Press, 2011).


30 fact, Lutz declared of the disease made pos sible its cultural significance, and its cultural significance encouraged 26 Others have since confirmed this view. In The Heart of Whiteness (2007) Julian Carter argues that neurasthenia helped to neutralize the political power of w hiteness, rendering it an invisible yet powerful default racial category for American national identity. 27 same title, and argues that the diagnosis of neurasthenia gave voice to individual and structural concerns about gendered expectations for men and women, and offered tangible yet diverse solutions. Transforming what previously may have been considered idleness, neurasthenia's requisite rest cures, vacations, and camps fa cilitated a new culture of leisure that did not conflict with the Protestant work ethic. 28 neurasthenia had made the condition a force in popular culture that spirituality, their 29 Schuster concludes that 30 Put anothe r way, according to F. G. Gosling, 31 Analysis of mainstream cultural icons such as 26 Lutz, American Nervousness, 22. 27 Julian Carter. The Heart of Whiteness: Normal Sexuality and Race in Ame rica, 1880 1940 (Durham: Duke University Press, 2007). 28 David G. Schuster. 1920. (New Brunswick, NJ: Rutgers University Press, 2011). 29 Ibid., 6. 30 Ibid. 31 F.G Gosling, Be fore Freud: Neurasthenia and the American Medical Community, 1870 1910. (Urbana, IL: University of Illinois Press, 1987): 87.


31 advertisements and cultural images leads both Carter and Schuster to affi rm the significant effect that neurasthenia discourse had on mainstream U.S. society. It seemed, at the end of the century, everyone already felt nervous and overworked, or worried they soon would be. The affiliation between nervousness and overwork posse ssed gendered implications refracted into gendered experiences of neurasthenia. Driven by sex difference theories that cast women as fundamentally different than men, scientific analyses of neurasthenia relied on gendered divisions of labor to describe how women became overworked differently than men. S. Weir Mitchell believed women became easily overwhelmed by prolonged academic study; their baser sensibili ties and constitutional frailty rendered them unfit for advanced education, especially during menses and prime reproductive years. 32 Overworked women typically exhausted themselves while performing their conventional gender role: the round the clock burden of the century librarians envisions neurasthenia as inherently a feminine condition. Citing Mitchell and others who singled out women as special sufferers of disease, her work argued women internalized the message that their reproductive systems made them particularly vulnerable t o neurasthenia. Librarians viewed their intellectual labor as a risk factor for neurasthenia. Though they continued in their profession, they had convinced themselves that doing so potentially subjected their bodies to neurasthenia and 32 Ladies Home Journal 27 no. 7 (June 1900): 14.


32 infertility. 33 Ano and activist Charlotte Perkins Gilman. In 1892, Gilman published a fictionalized short story about her own experience with the rest cure, as advised by Dr. S. Weir Mitchell. The short story, examples of how physicians leveraged their position of au thority to subdue women who challenged the gender roles assigned to them. 34 neurasthenia as decidedly a gendered illness, resulting from the shackles of the separate spheres for women, and the frustration they felt as homemakers. Furthermore, it portrays the physician as a powerful overlord over a helpless patient. This question of power in the doctor patient relationship dominates much of the history of the rest cure and clinical treatment about women and men Historians of medicine, especially those who write about insanity and mental illness, pay careful attention to the power abuse of power and the negativ e effects of lobotomy and electroshock therapy. For example, Andrew Scull views psychiatric trea tment as hardly scientific, but instead an impulse to instill a 33 Rosalee McReynolds, "Th e Sexual Politics of Illness in turn of Libraries and Culture 25 no. 2 (1990): 194 217. 34 This story is commonly taught in high schools as window into gender roles in the nineteenth century. Online reading guides, such as sparkno Mitchell) and sympathize with Gilman. Sparknotes identifies on e of the major themes of the story is to critique the ination in the home and her Other popular we bsites aimed at high schoolers contain similar readings, including and


33 bourgeois r ationality into patients by confining them in an asylum. 35 David Rothman echoes a similar anti psychiatry perspective. He viewed the asylum as a vehicle for increasing the need for psychiatric authority and care disguised as a well meaning medical solutio n. Elaine The Female Malady (1985) is considered one of the preeminent works on the treatment of women in asylums and, like Scull and Rothman, she finds institutions to be uniformly oppressive and exploitative. alady because it is 36 the rational scientific male, represented by the asylum, as an agent of social control over disfranchised, victimized women patients. While s eductive, the anti psychiatry arguments tell only part of the story about the treatment of neurasthenia. More recent scholarship rejects the view that asylums universally oppress patients, and that they disproportionately aim to control women. Other scho lars highlight the noble intentions of medical professionals as well as the material and structural The Mad Among Us 37 In this work, Grob lends a sympathetic lens to psychiatrists who, despite a host of barriers that prohibited ideal treatment -including lack of adequate funding, public suspicion about the restraint and drug treatments of patients, and pragmatic issues about treating ane, yet impoverished ones worked from benevolent intentions to help or even cure their patients. This perspective considers the doctor patient 35 Andrew T. Scull, Social Order/Mental Disorder: Anglo American Psychiatry in Historical Perspective Berkeley: University of California Press, 1989. 36 Elaine Sh owalter, The Female Malady. ( New York: Pantheon Books, 1985): 3. 37 Gerald N. Grob. The Mad Among Us: A History of the Care of America's Mentally Ill (New York: Free Press, 1994).


34 relationship a complicated one, not to be dismissed as mere exploitation of patient by doctor. As a result, sc holars, such as moved away from institutional studies to examine more intimate aspects of doctor asylums was not a result of misogyny, but of gendered presumptions about how women and men were different. She shows how these differences were negotiated between doctor and patient, and were held by doctor and patient alike. 38 Weir Mitchell humanizes the figure of the doctor and offers an analysis of his treatment as a negotiation not only between doctor and patient, but also between clinical practice and the social milieu. 39 This move away from Foucault, toward a frame for understanding how doctors and patients needed one another and gener ated medical meaning together provides a useful starting place for understanding neurasthenia. 40 This dissertation builds from the perspective that illness its definition, diagnosis, and treatment is negotiated among a web of forces: gender norms, racial intertwining all of these. These forces fluctuated in the Gilded Age, which makes it easy to see why such a broadly defined, so so many different kinds of ailments. I argue neurasthenia provided an essential language for 38 Nancy Tomes, The Art of Asylum Keeping: Thomas Story Kirkbride and the O rigins of American Psychiatry (Philadelphia: University of Pennsylvania Press, 1994). 39 Nancy Cervetti. S. Weir Mitchell, 1829 (University Park, PA: Penn State Press, 2012). 40 Another examples of scholarship t hat views a doctor patient relationship as a negotiation is : Naoko Wake, Private Practices: Harry Stack Sullivan, the Science of Homosexuality and American Liberalism (New Brunswick, NJ: Rutgers University Press, 2011).


35 men, specifically, to express how difficult it was for them to exist and persist in a rapidly changing world. Desp ite its conflation with femininity in popular accounts, I side with the camp of historians who believe nervous illness impacted men more significantly than women. The archetype of Victorian womanhood connoted femininity with frailty, so that doctors discu ssed published in the Gilded Age, F.G. Gosling concluded that physicians paid special attention to rvousness in men because they 41 Since a neurasthenia diagnosis required the that doctors paid special attention t nervous illness with a precise diagnosis. This explains, as chapter six will show, why only men general ities, whereas men required careful medical attention. In fact, men suffered from the emotional and nervous symptoms of neurasthenia long before the Gilded Age. Michael Micale argues, in his book Male Hysteria that historians neglected male nervous dise ase. A long tradition of connecting hysteria to the uterus rendered nervousness a woman centered history. Micale shows that male hysterics existed as early as the Renaissance, but alternative terminology or gendered interpretation obscured them as such. His work, though not expressly about neurasthenia, demonstrated that men experienced recognizable emotional and nervous problems well before 1869. However, as this dissertation argues, the economic, gendered, and racial shifts in the Gilded Age facilitat ed a new definition of masculine 41 Gosling, Before Freud, 47.


36 ill health. The rise of neurasthenia, I argue, reflected the heightened anxieties among white men in the late nineteenth century. The association between modernity and nervous men distinguished Gilded Age neurasthenia fr om hysteria or previous iterations of the disease. Historians note the use of metaphors about electricity used to articulate nervous exhaustion. 42 George Frederick Drinka h electric shocks inspired some of his therapies. 43 They also helped him frame the energetic loss among A person with a nervous tendency is driven to think, to work, to drive for success. He presses himself and his life force to the limit, straining his circuits. Like an overloaded giving rise to neurasthenia. 44 According to historian Roy Porter, these allusions to electric power combined with common and loss of vitality intertwined. 45 Barbara Sicherman concurred, characterizing neurasthenia as a 46 As these historians show, the language of neurasthenia borrowed from scientific and economic paradigms to express anxiety over health and well being. In this sense, Gilded Age neurasthenia 42 For a discussion of other medical diagnoses of modern anxieties, particularly those caused by the shock of railway travel, see Wolfgang Schivelbusch, The Railway Journey: Trains and Travel in the 19th Century (New York: Urizen Books, 1979); and Michael R Tri mble, Post Traumatic Neurosis: From Railway Spine to the Whiplash Chichester [West Sussex]: Wiley, 1981. 43 George Beard, The Medical Use of Electricity, (New York: William Wood & Co. Publishers): 1864. 44 George Frederick Drinka, The Birth of Neurosis: Myt h, Malady, and the Victorians (New York: Simon and Schuster, 1984): 191. 45 Cultures of Neurasthenia from Beard to the First World War Edited by Marijke Fijswijt Hofstra and Roy Porter. ( Amsterdam: Rodopi, 2001): 38. 46 Journal of the history of medicine and allied sciences, 32 no. 1 (1977): 34.


37 represented something new: anxiety borne out of the state of being rapidly propelled toward a mechanized, capitalist, and ever uncertain future. The popular portrait of the white, upper class neurasthenic, oppressed by their own superiority, synched with concurrent scientific theories about civilization and American nationalism. Namely, Lamarckian theory of acquired characteristics infused white supremacist and patriarchal ideas with scientific justification. In 1801, Jean Baptiste Lamarck posited that individuals acquired traits could be passed on to children. By the end of the nineteenth century, Lamarckian theory informed medical treatment of vice, and encouraged doctors to view al coholism, gambling, or masturbation as potentially inheritable traits. So, when neurasthenia emerged as a Only white male bodies had to capacity to be truly civilized. Yet, at the same time, 47 Stephen J. Ducat, in his gender history, The Wimp Factor motions, and 48 This dissertation builds on this explanation of neurasthenia as a paradox. I argue that the fact that fast paced industrial society simultaneously signaled the superiority of a society and also ruined its most prized citizens was actually the great strength of neurasthenia rhetoric. 47 Gail Bederman, Manliness & Civilization: A Cultural History of Gender and Race in the United Stat es, 1880 1917 (Chicago: University of Chicago Press, 1995): 88. 48 Stephen Ducat, The Wimp Factor: Gender Gaps, Holy Wars, and the Politics of Anxious Masculinity (Boston: eneral, is predicated upon


38 Furthermore, I argue it affirmed t he neurasthenic man as superior, regardless of his temporary status of debility. As Dr. Beard detailed diffuse and cumbersome symptoms of the neurasthenia epidemic in American Nervousness, he also provided evidence of American exceptionalism: the uniquel y American predilection for overwork and the capacity for superior intelligence. Beard himself suffered neurasthenia; so did S. Weir Mitchell. The two leaders in the medical treatment of the disease broke under the heavy pressure of their workload, and needed treatment. Because of the affiliation with intellect and civility, historians describe neurasthenia as fashionable and stigma free. 49 The Heart of Whiteness analyzes the ways neurasthenia rhetoric taught men to view their suf 50 Health and vitality of the male body were central to late 19 th centuries ideals about civilized men. These were tied to concerns about race. In fact, scholars argue whiteness and masculinity at the turn of the century were mutually constitutive forces. Gail Bederman goes as far to say that Americans were obsessed by racial dominance and its connection to manhood. hing, 51 brought evolutionary metaphors into the folds of social life and served t o justify racial hierarchies. Civilization discourse was found everywhere. A civilized man possessed an 49 Drinka, Birth of a Neurosis, 50 Julian Carter, The Heart of Whiteness: Normal Sexuality and Race in America, 1880 1940 (Durham: Duke University Press, 2007): 73. 51 Gail Bederman Manliness & Civilization: A Cultural History of Gender and Race in the United States, 1880 1917 (Chicago: University of Chicago Press, 1995). 4


39 intellectually developed mind, and by the turn of the century, a muscular and fit body. Gilded Age masculinity worked from the assumption that white men were more civilized than black 52 at the helm of the social order. 53 As a result, the neurasthenic breakdown reinforced racial and gendered hierarchies. 54 He argued: Without mentioning race or class in so many words, Beard made it plain that the nervous diathe sis was not to be found among the brawny laboring classes, or the stout peasants emigrating from rural parts of Europe, any more than among ex slaves or Indians. 55 White people, overcivilized and overstimulated by their urban routines, bore the emblem of n ervousness. Carter describes this phenomenon that circumscribed the white male body in a neurasthenia discourse which insulated it from critique. Even as he was breaking down in fits of nervous despair, the white man maintained a claim to whiteness (and to power via white supremacy). New emphasis on the muscular body threatened to undermine the nervous man. Changing body ideals in the Gilded Age marked a shift in ideals about manhood. Gail Bederman marked this period as a moment of transition, away from static definitions of manhood toward more nuanced descriptions of masculinity which could include positive and negative traits. 56 52 Bederman, Manliness and Civilization, 22. 53 Ibid., 25. 54 Carter, The Heart of Whiteness, 47. 55 Ibid. 56 Bede rman, Manliness and Civilization, 18.


40 The new emphasis on the body was, what Anthony Rotundo called a passionate manhood. 57 This new model eschewed the self restra int of earlier Victorian manhood. Instead, it championed the inner animal in a man. Passionate manhood emphasized muscularity and athleticism. Men specifically white men, often lower class took to boxing and weightlifting as leisure activities to demon strate their manly vigor in public settings. 58 Their muscularity signaled important distinctions from women; larger bodies provided a platform for scientific justification of so called masculine personality traits: brutishness, aggressiveness, promiscuity. physical weakness. The concept of manliness linked to economic concepts as well. The previous model of Victorian manliness required a quiet, reserved, restrai ned sensibility among men. Through man accrued the markers of respectability. Gail Bederman argues the urban and industrial trends of the late 19 th century made this type of manhood ideal impossible to achieve by 1910. 59 Work became more anonymous, placing an individual in a repetitive task and paying him by the hour. After work hours, men found increasing opportunities to spend their extra money in the commerc ial leisure culture. 60 The value of the labor so closely tied to manhood eroded, and the 57 Anthony Rotundo, American Manhood: Transformations in Masculinity from the Revolution to the Modern Era., (New York: Basic Books, 1993): 222 246. 58 John F. Kasson, Houdini, Tarzan, and the Perfect Man: The White Male Body and the Challenge of Modernity in America New York: Hill and Wang, 2001. 59 Bederman, Manliness and Civilization, 12. 60 Howard P. Chudacoff, The Age of the Bachelor: Creating an American Subculture (Princeton, N.J.: Princeton University Press, 1999 ): 146 184.


41 options seeking to replace that labor had previously been assumed to be frivolous wastes of time. Manhood needed refashioning to fit the urban industrial model. The ec onomic metaphor extended to the ways nineteenth century scientists interpreted G.J. Barker Benfield traced the nineteenth rm. In Horrors of the Half Known Life Barker 61 seminal work, American Nervousness, 62 Brain collapse, a synonym for neurasthenia, conjured a pending economic collapse, joining the body and the bank account in what Tom Lutz 63 Finally, ideals of masculinity reinforced white supremacy, and vice versa. Civilization discourse placed white masculinity at the apex of civilization, a standard against which white women and people of all other races could measure themselves. 64 It bound together the scientific justification of sterilization and eugenics movements. It emphasized the constitutional inferiority of non whites and the inherent differences between sexes. 65 It elevated rational thinking 61 G. J. Barker Benfield, The Horrors of the Half Known Life: Male Attitudes Toward Women and Sexuality in Nineteenth Century America (New York: Harper & Row, 1977): 167. 62 Beard, American Nervousness, 9. 63 Tom Lutz, American Nervousness, 1903: An Anecdotal History (Ithaca, NY: Cornell University Press, 1991): 12. 64 Matthew Frye Jacobson talks about this using the language of barbarism, which contrasted civilized Americans with so called barbaric inferior people throughout the world. This rhe toric, like that which was used to describe Barbarian Virtues: The United States Encounters Foreign Peoples at Home and Abroad, 1876 1917 (New York: Hill and Wang 2000). 65 Scholars acknowledge whiteness changes over time, and as a dynamic racial category, responds to changing social and political environments. The nineteenth century witnessed a significant expansion of who counted as white to


42 especially scientific inquiry over emotional or passionate response. Finally, it advanced procreative sex as more civilized and healthy than other forms of sex. 66 Overall, Gilded Age civilization discourse, out of which th e neurasthenic emerged, linked the desirable traits with American, white, reproductive manhood, and these with definitions of citizenship and power. Because of its close association with civilization, higher intellect, and rational thinking, scholars often characterize neurasthenia as a disease of the elite. It is not just that Beard promoted neurasthenia as the marker of higher civilization, but that historians appropriate this malaise endemic to the American bourgeoisie of the period. 67 He described the causes of 68 American Nervo usness, 1903, illness. Musicologist Gayle Sherwood Magee builds from Lears and Lutz in her recent biography of classical composer include Irish, It alian, and some Eastern Europeans. See Theodore Allen, The Invention of the White Race (London: Verso, 1994); Noel Ignatiev, How the Irish Became White (New York: Routledge, 1995). 66 In the 1880s and 1890s, the field of sexology emerged to observe, cla ssify, and diagnose sexual practices. Sexologists deemed some sexual practices more healthy and normal than others; they debated over the value of pleasure; they developed schema to identify and hierarchicalize different sexual behaviors and orientations. Historians view this era as crucial in the shift toward modern perceptions of sexual identity as opposed to behavior. See Michel Foucault, and Robert Hurley. The history of sexuality (New York: Vintage Books, 1988). Jonathan Katz, The Invention of Hete rosexuality (Chicago: University of Chicago Press, 2007); Harry Oosterhuis, Stepchildren of Nature: Krafft Ebing, Psychiatry, and the Making of Sexual Identity (Chicago: University of Chicago Press, 2000). 67 Lears, Jackson T.J., No Place of Grace: Antimod ernism and the Transformation of American Culture. (Pantheon Books: New York, 1981): 18 50. 68 Ibid., 56.


43 elite, urban disease. 69 While I agree that the cultural legacy of neurasthenia boasted intellec tual prowess and a civilized temperament for its victims, my findings show that the reality of nervous neurasthenia carried class and racial implications; but instead of viewing neurasthenia as an ailment for the elite class, I argue it affected men white men of all classes. As a result, it homogenized whiteness, permitting brainworkers and day laborers to share a similar identity that transcended social class differe nces. As chapters three, four, and five will show, cultural information about neurasthenia populated printed materials for audiences across the class spectrum. YMCA lectures and ads in the Police Gazette educated the working class men; books like S. Wei Wear and Tear captured the attention of wide audiences; and newspapers promoted archetypes of the beleaguered professional. Chapter six will show men across classes consumed and internalized these messages, and presented them to their doctors as their own. Clergymen and physicians spoke about sexual dysfunction, shame, and fear in the same terms that laborers and wallpaper hangers did. The argument that neurasthenia affected people across classes and outside major cities originated with F. country. His book, Before Freud, provides remarkable analysis of every medical journal article that addressed neurasthenia between 1870 and 1910. He locates the work of non elite general practitioners outside the medical hubs of Philadelphia, New York, and Boston to show that physicians across the country implemented the neurasthenia diagnosis. They also wrote about it: nearly one third of all professional papers on neurasthenia were presented at local meetings by 69 Gayle Sherwood Magee, Charles Ives Reconsidered (Urbana, Ill: University of Illinois Press, 2010): 84 85.


44 local physicians. 70 They used the same loosely defined criteria as their Northern, urban counterparts. Furthermore, Gosling shows these low profile practitioners who, unlike Beard, did not promote neurasthenia for prof essional gain found neurasthenia a helpful diagnosis for 71 promotion of neurasthenia as an elite diseased was challenged by physicians across the country. This disserta the center to show how men across class lines utilized the rhetoric of nervous manhood to describe their condition. I argue neurasthenic men participated in a shared identity that c emented their membership into the elite social network of whiteness and patriarchal manhood. By focusing on sexuality and the distress men felt when they believed they had transgressed boundaries for healthy or normal sex, this project illuminates how the Sexual Neurasthenia As early as 1879, Beard noted a gap in the scientific knowledge about the relationship of nerate scientific 72 Yet, he lamented doctors seemed unable to sufficient 70 Gosling, Before Freud, 78. 71 Ibid., 31 Gosling found subtle class bias in the treatment of neurasthenics. For example, doctors were often dismissed as blameless for their overworked condition, whereas neurasthenia in the laboring class would often be seen as the result of sexual excess. 72 New York Medical Record, 15. No. 4. (Jan 25, 1879): 73.


45 health. As a result, he found men to be of utmost importance for physicians when diagnosing and treating men with neurasthenia. e excess defined symptoms varied widely among patients. 73 Sexual Neurasthenia, first published in 1880, went ath. Physician A. D. Rockwell edition of this work has been exhausted more quickly than its predecessor sufficiently indicates its popularity and its rig never was there another case link unto or as severe as his own; and while you reassuringly tell him 74 Sexual neurasthenia required a keen sense and a thorough educati on on the subject. Hence, th century. ly 20 th century. 75 Reviewers championed the good work the book did in raising awareness of the large number of people who suffered in silence, and who could benefit from knowing about the treatments available for sexual uch about addressing medical concerns as it was about 73 Beard, Sexual Neurasthenia 45. 74 Sexual Neurasthenia 5e, George Beard (New York: E.B. Treat and Company, 1898). 75 Advertisement 13 -No Title, The Phrenological Journal and Science of Health (1870 1911) 113 no. 1; (Jan 1902): A10.


46 assuaging the enormous weight of shame and uncertainty men faced regarding their sexual behavior. The clinical term, sexual neurasthenia, appeared in euphemistic terms in advertisements, newspapers, an neurasthenia might experience. This dissertation will show that the sexual components of nervous i llness figured centrally in the cultural landscape of nervous illness. My findings show sexual concerns commonly affected white men across class lines. The scholarship about sexual neurasthenia minimizes its significance and pervasiveness among ordinary w hite men. Scholarly treatment of sexual neurasthenia either dismisses it or overemphasizes its acute application. Some accounts consider it one of the many forms of neurasthenia George Beard delineated, and gave it no special significance. 76 Others regar d the sexual neurasthenic an aberration associated with perversion. 77 For example, scholar Andreas 78 A few accounts acknowledge the ordinariness of sexual n book Before Freud, depicts a representative example of a sexual neurasthenic who frequently had sexual intercourse in his teenage years and had nighttime emissions as a young adult. 79 But even Gosling equates the diagnosis with 76 Toby Gelfand and John Kerr, Freud and the History of Psychoanalysis ( Hillsdale, NJ: Analytic Press, 1992): 102; Agnus McLaren, Impotence: a cultural history (Chicago: University of Chicago Press, 2007): 116. 77 Sexual Knowledge, Sexual Science, ed. Roy Porter and Mikulas Teich (New York: Cultures of Neurasthenia, ed. Marijke Gijswijt Hofstra and Roy Porter (Amsterdam: Rodopi, 2001): 168 170. 78 79 Gosling, Before Freud, 96.


47 80 Beard as a stepping stone to Freud, but uninteresting on its own. 81 Part of what made sexual neurasthenia rat her unremarkable for historians, I argue, is that it emerged from a Victorian era belief that masturbation and sexual excess signaled a moral failure in men and, in some cases, result in incurable insanity. For the medical profession in in the 1880s, it c ame as no surprise that George Beard would promote a medical diagnosis that connected sexual indulgence with polymorphously perverse infant, sexual neurasthenia could be easily overlooked. A few scholars have taken sexual neurasthenia more seriously, and this dissertation builds from their foundation. Kevin Mumford argued that the sexual health crises among men in the 1880s and 1890s reflected a larger social an xiety about shifting class and race boundaries. general and from impotence 82 The culture of manhood in the late nineteenth century hinged on the rejection of that which made a weak and nervous man. 83 As a result of socially acceptable depictions of nervous illness and sexual debility, Americans came to understand the 80 Gosling, Before Freud, 52. 81 George Makari, Revolution in Mind: the creation of psychoanalysis (New York: Har perCollins, 2008): 87. 82 Journal of the History of Sexuality 3 no. 1 (July 1992): 44. 83 Carter, Heart of Whiteness, 45.


48 84 Carter, like other historians of neurasthenia, finds significance in the cultural appropriation of neurasthenia, as a tool to express otherwise indescribable experiences. Carter describes neurasthenia as a way to a 85 I depart from the existing scholarship on neurasthenia and its sexual components. Specifically, I argue sexuality figured centrally in many case s of neurasthenia, not just ones designated as such in the official diagnosis. As chapter six shows, medical records and cases studies show men with general forms of nervous illness spoke about masturbation, sexual activity, and shame. I agree with Siche rman and Gosling that neurasthenia occurred across class lines; my findings confirm that laborers and scientists alike contracted the disease. However, too often historians take Beard at his word that elite people experienced sexual dysfunction differentl y than working people. My findings show sexual matters afflicted men across these differences. In fact, sexual symptoms turned up in all forms of neurasthenia, not just sexual neurasthenia. Finally, I combine cultural history methodology with investiga tion into clinical neurasthenia as a concept ; I argue that the clinical reality of neurasthenia provides a very important complement to this history. My analysis shows that men internalized the neurasthenia rhetoric that surrounded them, and mobilized it in the clinic in conversation with the doctor. The clinical setting served as a crucial site for men to confess their sexual indiscretions and for doctors to offer the m a form medical absolution. 84 Ibid., 72. 85 Ibid., 51.


49 1890s. It suggests men searched frantically for new definitions of healthy, manly expressions of sexuality. This work intervenes in sch olarship about the rising role of medical professionals whose success relied on expert classification and education skills. It also addresses a gap in the historiography on neurasthenia by showing how central sexuality and emotion were by the 1890s, to ne urasthenia rhetoric, generally. Bound up in ideas about whiteness and health, sexual neurasthenia (and its synonyms) affirmed whiteness and manliness as superior while simultaneously acknowledging pervasive evidence of weakness, sexual indiscretion, and n ervous breakdown.


50 CHAPTER 3 LAY MEDICAL LITERATURE : IDENTIFYING AND TREATING THE NEURASTHENIC MAN Introduction Men in the late nineteenth century avoided identifying themselves as ill and often looked upon medical professionals with suspicion. Becaus e Western culture historically coded weakness, nervousness, and disease as feminine, men preserved their claim to manhood by resisting any affiliation with sickness. Doctors found this to be particularly true for mental or emotional health concerns not ea sily observable on the physical body To admit some form of weakness risked an exposure of physic al ineptitude or permanent infirmary the reby unseating the tenets which justified the subjugation of women in society and their involuntar y institutionalizati on in asylums. Furthermore, a growing body of Gilded Age lay medical literature fueled two stereotypes about doctors: intimidating experts who cast judgment on the lesser informed patient; or self important dolts who sold q uack medicines to the uninforme d and sick. Men found many reasons to distance themselves from disease. For these reasons, neurasthen ia needed careful public image management. W ith three pages of everyday symptoms, neurasthenia possessed no clear metric for diagnosis; plus, alarming media coverage intimated anyone could potentially fall prey to the disease. The leading promoters of neurasthenia not only had to educate the public about what it was, but they had to present the illness as masculine, temporary, and safe to admit. In an age where scientific experts believed alcoholism, syphilis, and mental illness signaled a physical degeneration of a person, neurasthenia stood out as an exception. Weakness and sexual malfunction associated with nervous disease actually evidenced the su ensure the public became properly educated about neurasthenia, physicians wrote instructional monographs to disseminate the latest medical knowledge.


51 This chapter shows the lay medical literatu re about neura sthenia not only informed people about symptoms associated with mental, emotional, and sexual health it destigmatized these symptoms I argue that lea ders in the field of neurology framed nervous diseases in masculine ways, and sought to characterize docto rs as caring fellow men who not only understood the stressors of manhood, but could help patients cope with them. As neur asthenia s, saddling them with emotional instability, worry, fatigue, and many other symptoms, men increasing ly turned to doctors for help. This chapter demonstrates that men came to view doctors as allies because lay medical literature successfully portrayed neurasthenia as a temporary condition Un like some of the ail ments of women or insane people, which d octors viewed as mostly const itutional and permanent neurasthenia had an endpoint, and men who experienced it could strive for relief. More importantly, the literature environment. In contrast to dominant social Darwinist theories about the hereditary superiority of white people over other races, and men over women, the literature about neurasthenia presented the disease without blaming the victim. In fact, the victim typically developed nervous symptoms precisely as a credit to his vast intellect or other marker of superiority. Notably, m ost of the men who got diagnosed with neurasthenia, and all who would receive treatment for sexual neurasthenia under S. Weir Mitchell were white. This chapte r demonstrates the powerful role key monographs placed in reframing nervous disorders as manly experiences that not only neurasthenic precisely because being a white man in Gilded Age America was so difficult. This chapter focuses on the biography and writing of the S. Weir Mitchell, the architect of the rest cure. Mitchell believed that much the literature people read gave them faulty ideas


52 about health, illness, and medical care. So, a literary man as well as a physician, Mitchell published three monographs to help correct the public perception of doctors and nervous disease For decades, historians have built a self referential historiography that maligned the se books a medical justification for the marginalization of women. However, I am interested in what Mitchell had to say about men. 1 This chapter argues the case studies and medical advice in S. popular lay medical books drew from his own experience as a man with nerve illness the emotional agony his Civil War patients endured, and the neurasthenic breakdowns of his friends and colleag ues. These works provided powerful cautionary tales to men who needed to protect their masculine strength in the face of a fast paced, modern work environment He believed parenting, education, personal habits and social norms constituted the different expressions of nervous illness in women and men. In other words, he was n ot a strict determinist; in some important ways, h e understood differences between women and men physically and behaviorally to be the result of social training. Thus, he called for rigor o us treatment to combat or correct the debilitating influence of urb an, sympathy and understanding which meant not only women needed these things, but so did any man who found himself victimized by their environment From health to show how he provided a valuable framework for men to understand themselves as neurasthenic. 2 And it worked. As chapter six will show, men flocked to Mitche ll with some of their most deeply held secrets, especially regarding their fears about sexual performance and 1 J American Historical Review 91, no.5 (December 1986): 1053 1075. 2 Ibid., 1053 1075.


53 satisfying social expectations set for men Mitchell embodied the trustworthy physician he popularized in his monographs. Newspapers, medical ci rcles, and literary clubs heralded Mitchell with a deep respect. T o understand how men not only came to understand themselves as neurasthenic, but also how they came to view the physician as the best resource for a cure, t his chapter will trace the develo imp ortant to consider how Mitchell developed the rest cure first by treating male patients; he then adapted the rest cure to treat women. Partly, t he significance of this argument is h istoriographic because so much scholarship about Mitchell describes him as a misogynist. on women, such as his infamous article published in Ladies Home Journal in 1900 entitled education or the college life in any way, body or mind, unfits women to be good wives and 3 In a memorial speech a c olleag u e and friend, Dr. Burr writing that declared women as physiologically different from and inferior to men, and therefore incapable of pursuing the type of public or professional r oles reserved for men. Burr affirmed Mitchell 4 During his life, Mitchell received criticism for his views. The infamous case was Charlotte Perkins him as a patriarchal villain who abused his position of authority to silence women into 3 Ladies Home Journal. Jun 1900 Vol. 17 No 7. P 14. 4 Charles W Burr, S. Weir Mitchell, Physician, Man of Science, Man of Letters, Man of Affairs ([Philadelphia]: The College, 1920): 31.


54 looked to i t as evidence of a long history of misogyny that characterized doctor patient relationships. 5 d claims. Notably, Elaine Show The Female Malady ppropriate behavior marked a clear boundary between mental health and illness; thus, insanity could be mobilized as a way to stigmatize women who fell outside the boundary of respectable femininity by saddling them with a medical diagnosis. 6 quips about women made him an easy work as a representative example of the ways late 19 th century medicine justified exclusion from education, employment and political participation. 7 He encouraged twenty first century readers to 5 Arizona Quarterly: A Journal of American Literature, Culture, and The ory 60, no. 2 (2004): 57 85. 6 Elaine Showalter, The Female Malady: Women, Madness, and English Culture, 1830 1980 (New York: Pantheon Books, 1985). 7 popularized it as evidence of the oppressive nature of mental health care: feminism and anti psychiatry. Radical feminist circles in the 1970s circulated the story as evidence of the patriarchal oppression of women by men in power. Analysts viewed autobiography, The Living of Charlotte Perkins Gi lman. representative of the type of treatment doctors gave women patients with psychosomatic illness. They lumped an illness affecting as least as many men as wom en -with hysteria, a diagnosis reserved for women and which some doctors used to justify unnecessary treatment. 7 Hysteria, as a has been expla urate. See also Foucault, Michel. The Birth of the Clinic: An Archaeology of Medical Perception New York: Vintage Books, 1994; Michel Foucault, Madness and Civilization: A History of Insanity in the Age of Reason New York: Vintage Books, 1988; Lunbeck, E lizabeth. The Psychiatric Persuasion: Knowledge, Gender, and Power in Modern America Princeton, N.J.: Princeton University Press, 1994. Bayer, Ronald. Homosexuality and American Psychiatry: The Politics of Diagnosis New York: Basic Books, 1981; Scull, Andrew T. Social Order/Mental Disorder: Anglo American Psychiatry in Historical Perspective Berkeley: University of California Press, 1989; Rothman, David J. The Discovery of the Asylum: Social Order and Disorder in the New Republic Boston: Little, Brow n, 1990.


55 wome 8 Kimmel describes Gilman as within the oppressive confines of the rest cure at the hands of S. Weir Mitch ell. 9 While this approach has fostered vibrant debate among scholars, it has also neglected and how it affected men, too. My analysis shows Mitchell presented himself as a progre ssive and sympathetic physician who knew from intimate experience about being an overworked neurasthenic He drew from front line training during the civil war, and from witnessing professional burnout among his colleagues. Beyond the historiographic interventio n, sympathetic view of neurasthenic men demonstrates how a far reaching, and well received portrayal of nervous illness in the Gilded Age evaded stigmas of femininity or insanity Mitchell leveraged his acclaim to educat e the public about the pressure white, American men faced; he normalized their suffering and encouraged them to seek treatment. As a result, many men in the late nineteenth defined themselves as neurasthenic, and to use the language of neurasthenia to exp ress and cope with a range of emotional, mental, and physical symptoms they experienced. Medical Training and Early Career of S. Weir Mitchell training occurred while tending to soldiers during the Civil War. What may seem obvious to a twenty first century reader such as the healing power of fresh air and plenty of rest was not common practice in antebellum hospitals. 8 Michael Kimmel, introduction to Wear and Tear, or Hints for the Overworked, S Weir Mitchell. (Walnut Creek, CA: AltaMira Press, 2004, 1887): v. 9 Ibid.


56 in terest in the nervous system and inspired his career in nervous disease. Furthermore, his own bout with nervous illness engendered intimate knowledge about the physical and emotional tax of the disease. He learned to empathize with patients in a new way, and found this type of Therapeutic methods would eventually dominate the medical landscape in the 20 th century, but in the late 19 th a sympathetic confessor was unique. Th erefore, biographical information of Mitchell as a Civil War surgeon and as a neurasthenic in the Gilded Age. In the years leading up to the Civil War, S. Weir fessional responsibilities collided to place significant demands on income. He worked alongside his father, Dr. John Kearsley Mitchell, a renowned physician who operated a thriving clinic in local r his son, and in 1857, Mitchell reported an annual income of $2,000. 10 Though clinical work he performed it after hours. M ost midcentury physicians believed laboratory work sullied the rep utation of a clinical physician. However, as a young, unmarried Mitchell managed to balance his patients along with h is laboratory experiments. As his father aged and succumbed to illness, Mitchell assumed a heavier patient load to sustain the family practice. In April 1858, J. K. Mitchell died. Mitchell described his 11 The grieving family remembered its patriarch fondly as an engaged father and dutiful provider Thus they 10 11 Ibid.


57 were surprised to learn, upon settling the affairs of his estate, J.K. Mitchell left no financial support for his widow a nd young children. Furthermore patients in the family practice rejected the young Weir Mitchell as the sole p ractit ioner and they took their business elsewhere The family income dropped by half. Stress mounted for Weir as struggled to balance all t he stress. The financial squeeze combined with the emotional Mitchell feeling immense pressure to support his family. In a memorial speech, Dr. Charles Burr eer and skittles; it was a period of hard, 12 As it was unfolding, Mitchell remained aware of the perils of exhaustion. He wrote that these events his health by the end of 1858. 13 mily life only caused greater responsibilities. Mitchell joyfully announced his engagement to Mary Middleton Elwyn an occasion that brought Mitchell happiness as well as additional responsibility. Mitchell wrote of his romantic affections for Mary Elwin, but marriage also caused Mitchell to assume additional financial obligations because his wife h ad no means of her own. The couple wed in September 1858. floundering salary would have to support his mother, his three younger brothers, and his n ew wife. He could no longer afford to continue his beloved in his laboratory because it generated very litt le income or renown. S addled with the breadw inner role, Mitchell decided he could not jeopardize his reputation as a physician. By 1861, he reluctantly abandoned the laboratory and slowly 12 Charles W Burr S. Weir Mitchell, Physician, Man of Science, Man of Letters, Man of Affairs ([Philadelphia]: The College, 1920): 9. 13


58 rebuilt his patient load in the family practice. This proved a turning point for Mitchell : he would remain an active physician for the next four decades. 14 The onset of the Civil Wa heightened his obligation to remain in Philadelphia to look after them. His brothers Edward (known to the family as Ned), Chapman, and Robert left home for service. Ned, the youngest of the three, died o f diphtheria during the war, stirring a wave of regret and responsibility in Mitchell. The Union army offered Mitchell a position as a brigade surgeon, but he turned it down, mostly afraid to leave his mother without dependable support. Instead, Mitchell worked a few days a week at his own practice, and in 1862, he accepted a position as a military contract surgeon in temporary hospitals caring for wounded soldiers. 15 Philadelphia provided Mitchell a vibrant and dynamic medical community during the Civil War. The City of Brotherly Love first appointment was at Filbert St. hospital where he took interest in the little known nervous diseases. Other men disliked handling nervous disease and transferred nervous cases to Mitchell for treatment. His interest soon spread and the surgeon general created a small hospital for him on Christian Street. Known as Commi diseases. Demand for treatment quickly ou tgrew the crowded hospital so it moved to a larger 16 Unlike most Civil War hospitals, the Turner Lane hospital fashioned itself a modern 14 15 Erne st Earnest S. Weir Mitchell: Novelist and Physician (Philadelphia: University of Pennsylvania Press, 1950): 48. 16 tinction between somatic and mental/behavioral disorders. He would not make this


59 facility, mainta ining cleanliness standards and dressing itself in white. The most pressing problem was gangrene. 17 The tent hospitals Mitchell previously worked at circulated air e trapped air and moisture, encouraging the spread of gangrene among patients. To remedy the problem, Mitchell moved patients with n outside tent. This inspired air movement as a cure for disease. 18 Other elements of the Turner Lane experience would inform his later work on the rest cure: the physicians were among the first to treat patients using massage and atropine. They conducted pioneering research which in spired several publications on nerve treatments. Civil War casualties prompted a rapid reconfiguration of gender and medicine. Prior to the war, men recovered from illness or injury at home under direct care of the women in their families. Perhaps a male doctor advised the family, but routine care of the sick lay under the purview of women. The tent hospitals like those at Turner Lane marked a new experience for soldiers most had never gone to a hospital before. Furthermore, most had never received nurs ing care and bedside attention from a man before. In wartime hospital environments, as Margaret Humphreys shows in Marrow of Tragedy, men took on both the conventional role of medical expert and surgeon, but also the feminized role of nurse and caretaker. Men found themselves in the midst of what Humphreys term 19 Wartime distinction in print until later and even still, in convoluted ways but in his autobiography, he remembers making the distinction in practice as early as the Civil War. 17 See Frank R. Freemon, Gangrene and glory: medical care during the American Civil War (Fairleigh Dickinson University Press, Madison [N.J.];London, 1998). 18 Earnest, S. Weir Mitchell, 48 58. 19 Margaret Humphreys, Marrow of Tragedy: The Health Crisis of the Ame rican Civil War 2013): 20. A majority of the historiography about gender and Civil War Medicine focuses on women. For information about the important work women contributed during the war, see Jane E. Schultz, "The inhospitable hospital: gender and


60 conditions forced men to perform sewing and cooking. 20 In essence, 21 At Turner Lane, Mitchell did just that. The specializ ed care offered at the Turner Lane facility not only inspired surgical innovation but also facilitated attentive holistic treatment of wounded soldiers. 22 Certainly, physical inju ry of the nerves warranted immediate medical attention, but Mitchell took interest in being as well. among soldiers who seemed shaken and distraught by their war experiences. 23 T his was the first indication that nerve injury impacted more than the physical body, that war caused emotional and mental health casualties also 24 career and expertise in nerve illness. His work wi th soldiers intrigued him and gave him purpose prof essionalism in Civil War medicine." ( Signs: Journal of Women in Culture and Society vol. 17, no. Winter 92, 1992): pp. 363 392; Jane E. Schultz and Inc NetLibrary Women at the front: hospital workers in Civil War America University of North Carolina Pre ss, Chapel Hill, 2004; 20 Historians engage in lively debate about the concept of separate spheres in the 19 th century. Earlier The Bonds of Womanhood as necessarily separ as mutually constitutive and not altogether segregated. As a result, historians now believe the concept of separate spheres functioned more as a middle class white i Two important contributions to the development of this field focus on England: 21 Margaret Humphreys, Marrow of Tragedy: The Health Crisis of the American Civil War 2013): 20. For more on th e ways in which the Civil War affected gender norms see also Nina Silber and Catherine Clinton Divided houses: gender and the Civil War Oxford University Press, New York, 1992; Ira M Rutkow. Bleeding Blue and Gray: Civil War surgery and the evolution of American medicine Random House, New York, 2005. Brian C Miller,. Empty sleeves: amputation in the Civil War South The University of Georgia Press, Athens, 2015. 22 For more about the medical knowledge gained as a result of the Civil War, see Shauna Devine Learning from the wounded: the Civil War and the rise of American medical science The University of North Carolina Press, Chapel Hill, 2014. 23 Earnest, S. Weir Mitchell, 48 56. 24 Mitchell would later explore the psychic devastation of war on men in Civi l War fiction. Roland Blake is the most well known example. See Anne Stiles, Neurology and Literature, 1860 1920 (Basingstoke [England]: Palgrave Macmillan, 2007).


61 akin to laboratory research He was able to split his time between his military duty at Turner Lane and clinical practice at home. But these dual workloads sapped his energy, leaving little left for family social obligations, or himself. Then his wife, Mary Elwyn died of diphtheria and this set in motion a cascade of events that would degrade his psychic and physical state even further The co uple had two children: John, age 3, and Langdon, an infant. Already stressed b y his obligations at Turner Lane and in private practice, Mitchell had no time for domestic labor or childrearing. He agreed to allow his unmarried sister Elizabeth Mitchell to move in and assume the maternal role for the boys. She ke pt the home as well. But Mitchel l On July 5, 1863, the Union army called Mitchell to Gettysburg. Nothing could prepare him for the sight of 27,000 wounded men on the battlefield a rattling image that imprinted in his me mory. Quick to work, he helped deliver all 27,000 men treatment and shelter within 24 hours. Later that month, the army sent Mitchell to the Union prison at Fort Delaware a site notorious for its awful conditions. According to Civil War historian Lonn ie Speer, 25 Inmates endured violence, forced labor, and debilitating torture. 26 Mitchell felt overwhelmed by what he saw there, and grew sour about the physical and mental atrocities war engendered. He also felt powerless to help. Nonetheless, the trip taught him he returned to Turner Lane with a plaguing his patients. Gettysburg and Forth Delaware showed Mitchell firsthand the un heroic, thankless aspects of military service. These experiences informed his medical practice by 25 Lonnie R Speer and Inc NetLibrary Portals to hell: military prisons of the Civil War (S tackpole Books, Mechanicsburg, PA, 1997.): 77. 26 Ibid.


62 showing him that physical injury and mental anguish assailed men inextricably. The costs of war included the limbs and lives of soldiers, but Mitchell believed it also took the human spirit hostage. The psychic malady to drive his medical practice for the rest of his life. Though Mitchell gained wisdom and empathy for soldiers during his travel to warzones, these ex periences weighed heavily on his own health. When he finally returned to Philadelphia, he was grief stricken, disturbed, and exhausted. 27 In early 1864, he had enough and decided to buy himself out of his military duty. Certainly the demands of the war e ffort left him little time to grieve the loss of his wife and brother, Ned. He needed a break from the professional and emotional stress of military life A $400 fee relieved him of his hospit al obligations at Turner Lane and he looked forward to the co ntrolled setting of running the private practice out of his and capricious brother Wally returned penniless, from adventures out West and stirred tension wi thin the family Business hours were booming Mitchell saw 20 patients a day! and he struggled to keep the pace. In spring 1864, Mitc hell had a nervous breakdown. 28 Convinced he needed fresh air and liberation from personal and professional demands, Mitc hell promptly abandoned his practice, and his family, and headed to Europe. 29 He spent a few leisurely months in England and France. The rest rejuvenated him and he returned to Philadelphia in July 1864 with renewed commitment to medical practice. His tr ip also afforded him a profound appreciation for the therapeutic value of rest and fresh air. Mitchell had known 27 Earnest, S. Weir Mitchell, 56. 28 29 Ibid.


63 escape from being a patient because of being a 30 writings indicat e particular sensitivity to brain tire and overwork by virtue of their demanding profession. He defined brain tire as fatigue caused by overextension of the mental faculties. By th e mid 1860s, Mitchell saw nervous debility not as exclusive to war weary soldiers, but potentially affecting any person who over exerted their intellectual reserves. Mitchell carried these lessons from military service into his treatment of men in priva te practice. In 1872, Mitchell attended a patient who suffered from locomotor ataxia, a nerve disorder known to limit movement. The rather mysteriously patient broke his thigh while walking and spent three months recovering in bed. When the patient emer ged from bed rest, he instantly broke the other thigh, and spent three more months in bed. The connection between ataxia and broken bones puzzled Mitchell. But when the patient emerged from bed rest after the second break, with healed bones and steeled n erves, Mitchell concluded two things: ataxia caused brittle bones, which explained the susceptibility to breakage; more importantly, rest was valuable in cases of nerve disease. At this point, it became obvious to Mitchell there was a therapeutic value t o bed rest and it is significant to note that his training came from his experiences with other man, and as a man himself. vacation, and the unexpected benefit of rest for curious interest in the rest cure as medically valuable and manly -treatment. To this point, he had stumbled upon these successful treatments and ascribed the curative value of fresh air and rest only in retrosp ect. I argue his medical evaluation of nervous illnesses is necessarily 30 Mitchell, Doctor and Patient, 58.


64 gendered, and based in his belief that strict gender role expectations that men bravely fight in battle, that they withstand military trauma without expressing despair, that they bear the sole economic responsibility for their families even without the supporting labor of a wife. 31 Mitchell developed the rest cure as a response to the constraints he witnessed among men. Nervous illness resul ted from the strict pressures on women, to o. In fact, the first time Mitchell implement ed his lessons from civil war soldiers occurred with the case of Mrs. G. of Maine in January 1874. Mrs. G had given birth to several children in rapid succession and maintained active engagement in charitable work while pregnant and nursing As a result, she suffered extreme exhaustion. Mitchell described her as 32 She was an intelligent woman, but illness rendered her fati gued by thinking, reading, concentrating her eyes, or conversation. Eating proved difficult and she could only keep meals down when she ate alone, in the dark, and in a prone position. Strict bed rest allowed her to eat, but too much rest caused nausea a nd vomiting of undigested food. Her feeble body could withstand little movement and her exercise was limited to shuffling across her bedroom each day. Prior to seeing Mitchell, she went to physicians and gynecologists who diagnosed her with hysteria and proscribed every treatment available, from tonics to spinal supporters. Nothing alleviated her symptoms, and Mrs. G. e 33 31 Today, gender scholars describe this phenomenon as gende r role strain. While risking anachronism, thinking connections between the ways gender roles harmed men in the past, and the ways they continue to do so today. For more on ways social scientists investigate contemporary instances of gender role strain, see 32 33 Ibid.,3.


65 G. and found her extreme weakness a likely symptom of nervous excitability. 34 Rest alone caused the sick woman to regurgitate her food undigested. T oo much movement resulted in fatigue. Mitchell believed form of exercise, but he struggled to reconcile the two seemingly contradictory treatments While contemplating the case, he recalled seeing use violent and vigorous rubbing to relieve a sick man of paresis. He considered this migh t work well for Mrs. G., too. He brought a young girl to Mrs. G. and instructed her in the same manner. A few days later, he applied daily Mitchell increased her diet, added iron and more food between meals At all other times, Mrs. G. remained secluded in bed. Within ten days she 35 This experience taught Mitchell the value of overfeeding the patient through a unique combination of 36 These became the hallmarks of the rest cure to restore 37 Mrs. G. made a full recovery in three months time. Mitchell publicized the successful rest treatment of Mrs. G in lectures at the Infirmary for Nervous Disea ses at the Orthopaedic Hospital where he worked. In 1875, Edward Seguin included the lecture in his series of American Clinical Lectures. In the talk, Mitchell prompted doctors to see beyond the rest cure, and to pay careful attention to what comes afte r the rest. He 34 Ibid. 35 Ibid.,4. 36 Ibid. 37 Ibid.,5.


66 38 Because patients often resisted the instruction to remain in bed for extended pe 39 the patient. Mitchell found women to be easier to treat because they had been socialized to conceive of themselves as medicalized subjects and more readily followed instructions from a doctor. He believed women were more were less likely 40 and required more confident pressure to He detailed the many uses for the rest cure, from curing nerve damage to broken bones, to locomotor ataxia. He included one case of hysteria, though he made sure to express his maladies. It were as well called mysteria for all its name teaches us 41 Despite his playful reject ion of hysteria as a useless diagnosis a common reaction he provided a detailed c ase study of the effectiveness of the rest cure even in such nebulous circumstances. 42 Likely a reiteration 38 A Series of American Clinical Lectures ed. E. C. Seguin (New York: G.P. Putnam's Sons, 1876): 83. 39 Ibid., 84. 40 Ibid. 41 Ibid., 94. 42 Mitchell frequently disparaged hysteria as a meaningless diagnosis. Additionally, he s aw neurasthenia and hysteria as distinct diseases. Neurasthenia was free of the long, feminized history of hysteria, and connoted intellect, civility, and a strong work ethic. See Lillian R. Furst, Before Freud: hysteria and hypnosis in later nineteenth century psychiatric cases (Lewisburg: Bucknell University Press, 2008); Rachel Maines, The Technology of


67 of the case study of Mrs. G, described earlier, the story of Mrs. B. also involved rigorous massage, treatment with electric currents, and abundant 43 Mitchell firmly believed in the curative power of the rest cure, and through his successful treatment of women, he attracted the attent ion of the broader medical community. Early reviews of the rest cure spoke positively of the treatment. A reviewer in the Philadelphia Medical Times offered the insight. 44 In fact, it called up on Mitchell to publish in more detail on the subject, and expand the 20 page pamphlet into a longer book Meanwhile, he continued to apply the tre atment to other cases and gave a lecture about it to the Medico Chirurgical Faculty of Maryland in 1877. In response to letters from colleagues inqu i ring about the specifics of the treatment, Mitchell endeavored to write a longer, more comprehensive work. 45 Mitchell published Fat and Blood and How to Make Them in 1878 as an instructional guide to the rest cure for physicians He presented a full description of the rest cure for medical professionals wishing to integrate it into their practice. The book length treatise devoted a separate c hapter to each aspect of the rest cure. Orgasm: "Hysteria," the Vibrator, and Women's Sexual Satisfaction (Baltimore, Md: Johns Hopkins University Press, 1998); Andrew Scull, Hysteria: The Bi ography (Oxford: Oxford University Press, 2009). 43 44 "Reviews and Book Notices," Philadelphia Medical Times (1871 1889) 5, no. 46 (Aug 14, 1875): 733. 45 Mitchell, Fat and Blood, 10.


68 and fat. 46 Mitchell argued for the importance of fat reserves to help pati ents withstand physical 47 Readers may have typically associated fat with excess and alcoholism, but Mitchell believed some fat an essential component of a healthy body. Gaining fat aided the bl ood and together, these strengthened the body enough to ward off fevers, pneumonia, and other illnesses. 48 Fat and Blood instructed doctors to at tend to the particularities of each discretion w needs. Some patients require d strict bed rest while others benefited from exercise; still others like Mrs. G., needed a combination of both. Psychic rest was ess ential also. Mitchell permitted someone may read to patients between one to three hours a day. 49 Otherwise, patients extracted themselves from social obligations, stressful situations, and mental labor. Mitchell expressed a keen awareness of the way s in which gender influenced an but spends much more time describing the conditions of women. and at length. F irst he acknowledged the stereotypical conflation of illness with femin physician, -50 As a result, physicians of 46 La te nineteenth century medical perspectives on blood viewed the viscosity of blood to lend crucial insight into a thinness. 47 Mitchell, Fa t and Blood, 23. 48 Ibid., 25 26 49 Ibid., 44. 50 Ibid., 9.


69 through many ha 51 His comments rest on a presumption that all physicians shared simila r experiences with women, that all readers of Fat and Blood dealt with women frequently in their offices, complaining of illne ss. Most often, according to Mitchell, women registered a litany of symptoms of nervous exhaustion: fatigue, headache, trouble sleeping, indigestion, and menstrual trouble. These symptoms wrought even the firmest women lose self control affirmed two presumptions: that physicians were well aware of the complai nts of nervous exhaustion among women ; and that t he most common and visible manifestation of nervous exhaustion came in the form of a sick woman. abruptly conclude d 52 He went on to expl ain: time seen soldiers who had ridden boldly with Sheridan or fought gallantly with Grant become, under the influence of painful nerv e wounds, as irritable and hysterically emotional as the veri e st 53 The next sentence return ed to the subject of women women thu s disordered is at last the bed albeit concise, addendum 54 because histor ians have overlooked it. But, Mitchell stated plainly that nervous illness drove men into vulnerable states, both physically and emotionally. Not only that, but those who 51 Ibid., 9. 52 Ibid., 30. 53 Ibid. 54 Ibid.


70 embodied the manliest ideals as warrior and protector Civil War soldiers fell victi m to the same symptoms that brought women to their doctors in droves. Certainly gendered labor, such as military service, did little to protect men from the debilitating effects of nervous illness. Mitchell used the example of police officers to demons trate how manly, protective labor did not immunize men from the loss of fat and blood. He conducted a study on police officers in large majority of the men ha 55 Men of working classes, he concluded conducted hard labor in the hot sun. However, wealthier men tended to gain weight during leisurely activity in summer months in fact, extended rest treatment, such as police officers, shows he was keenly aware of not only outside, physical, and constant not only affected their health negatively but also precluded the leisure activities that could m itigate negative impact. 56 Mitchell s instructions to physicians in his long awaited Fat and Blood encouraged them to see nervous illness as contingent upon gender and social class. He also prompted his audience to resist overt judgement of patients who se symptoms seemed too diffuse to be anything but hopeless discontents. In doing so, he legitimized the complaints of so called hysterical women the emotional irascibility, the despair, the listlessness -that often frustrated physicians. Furthermore, Fat and Blood 55 Ibid.,16. 56 Ibid.,15.


71 mainstream medical knowledge. This may have done nothing to redress sexist presumptions of Doctor and Patient, Mitchell presumably menses and potential for childbirth for their higher likelihood of many diseases compared to men. 57 In other words, illnesses were primarily environmental subject to climate, lifestyle choices, and I argue, gendered expectations uniquely placed onto boys and men. The professional responses to Fat and Blood were lukewarm, at best A reviewer in th e Medical and Surgical Reporter, 58 Mitchell acknowledged potential criticism in the conclusion of Fat and Bl ood. He wrote exceptional value of the treatment which I now leave to the judgment of the larger jury of my 59 Fellow physician and friend, Charles Burr, wrote that some physicians balked at the attempt to write lay literature to attract patients; they criticized his attempt to educate the public and implied that doing so was an immoral strategy to make money. Other 60 Yet Mitchell had be en so confident his experience yielded firm results. In his autobiography, Mitchell recalled feeling devastated by the initial criticism of his work. 61 57 Mitchell, Doctor and Patient, 84. 58 "Review 1 -no Title." Medical and Surgical Reporter (1858 1898) 37, no. 10 (Sep 08, 1877): 194 59 Mitchell, Fat and Blood, 106. 60 Charles W Burr, S. Weir Mitchell, Physician, Man of Science, Man of Letters, Man of Affairs ([Philadelphia]: The College, 1920): 12. 61


72 The public reception of Fat and Blood was more significant. Lay readers found Fat and Blood advertis ed in the newspaper, alongside various other nonfiction works. 62 A West Virginian newspaper promoted the book in an article about the merits of the rest cure in treating ommon Diseases in Philadelphia. 63 Fat and Blood enjoyed a wide l ay audience who could relate to the conversational tone and seemingly straightforward remedies. 64 As a result, Mitchell continued attracting clients and practicing the rest cure. The cultural significance of the rest cure grew, even as the medical communit y was slow to accept its legitimacy. The rest cure gained professional credence in the early 1880s, when British obstetrician William S. Playfair endorsed the rest cure before European audiences. Playfair brandished photographic evidence of physical reju venation of the rest cure of patients: a series of before and after photos spoke to the contrasting the somatic states these patients, all women, experienced. Before treatment, patients were gaunt and lifeless. Their lips turned down and their eyes sunk into the dark circles on the thin flesh beneath them. After treatment, each woman appeared plump and stron g, Historian Michael Blackie called of the healthful effects of diet, massage, electricity, isolation, and res t. 65 The allure of modern technological representations via photograph turned out to be quite compelling. By the mid 62 The Cincinnati dail y star. ([Cincinnati, Ohio), 18 Aug. 1877. 63 The Wheeling daily intelligencer. (Wheeling, W. Va.), 10 Sept. 1877. 64 Earnest, S. Weir Mitchell, 77 78. 65 ographs. Originals are housed at the College of Physicians in Philadelphia.


73 1880s, t he tide of professional opinion followed a growing public awareness of and sympathy for rest cures for nervous illness. Mitchell reflected this, and more boldly 1880s: Growing Visibility of Nervous Men Before men would seek treatment from a doctor, they first needed to recognize their conditions as illness in n identify symptoms of nervous illness and recognize the pervasive and dire consequences for neglecting proper treatment. The causes of nervous illness were ubiquitous, especially in citie s where flourished. 66 Mitchell death rates in cities For example in Chicago, the population increased dramatically between awake 67 According to unpublished mortuary records from Dr. J. H. Rauch, the Sanitary Superintendent of Chicago, t sharply and disproportionately risen during this time. Records show death from apoplexy, palsy, increased 20.4 times, ac counting for one in 10 deaths by 1868 (a rate up from 1 in 26 deaths in 1852). While many nerve diseases result in death, others, like neuralgia merely cripple the patient. Thus the mortuary statistics, as alarming as they sounded, und erstated the true impact of nerve illness. 66 Mitchell, Wear and Tear, 23. 67 Ibid.


74 next two books built from his early success and addressed a broad public audience Mitchell published Wear and Tear, or Hints for the Overworked in 1887, and Doctor and Patient the following year. Both monographs ad dressed the lay public directly and in plain terms. 68 Wear and Tear described the nature and condition of nervous illness. In it, Mitchell described neurasthenia through the experiences of personal friends and colleagues, esteemed men whose professional ro les burdened their mental acuity and physical fortitude. He emphasized the ubiquity of nervous illness and cautioned the public that it could happen to anyone. Mental and physical symptoms intertwined, and manifested differently in each patient. Wear an d Tear served as a guide for lay readers to recognize their own symptoms in the stories of others, and to acknowledge the need for medical care. Doctor and Patient focused on the treatment and set an unofficial standard for physicians to follow, both as stewards of the rest cure and as potentially overworked, nerve weary patients themselves. In both books, Mitchell devoted significant time to exploring the ways in which different social expectations for girls and boys both privately at home, and in publ ic institutions such as school bred gendered outcomes in teens and adults. portrayed men as powerful bastio ns of civilized society that is, white, professional, urban men whose illness stemmed from an environment that not only sapped their resources, but too often ignored their suffering. To the public, Mitchell painted nervous illness as a symptom of industrialized life, afflicting white working men precisely because they were at the helm of social, economic, and intellectual progress. To physicians, Mitchell insisted neurasthenic patients especially 68 The 2004 reprint of Wear and Tear by AltaMira Press prefaced the primary text the same way it introduced Fat and Blood : as an example of misogynist medical perspectives from the late nineteenth century. In the opening text,


75 men suffered gravely from their environments, and should be taken seriously and treated with respectful sympathy. Together, I argue, these books successfully supported a social constructionist perspective on gender, coded quotidian and diffuse symptoms with a manly legitimacy, and instructed doctors to view sick men as vict ims of unfortunate circumstance. igins of sex differences, and prevailing medical paradigms used material evidence rooted in the body brains, musculature, or energy forces to justify institutional privilege of men over women. As chapter two historians condemn Mitchell for holding views which branded women as fundamentally more sickly and less intelligent than men, I argue that blanket condemnation misses his subtle yet per sistent recognition that social pressure and environmental demands debilitated anyone woman or man. importantly it pr ovides insight into the way the public came to learn about neurasthenic men. Through them, Mitchell instructed the reading public to understand gendered social roles as outcomes of distinct training: a well supported person could move through life with he alth intact ; however increasingly, and as leading neurologists argued, especially in the United States, modern life posed significant challenges to stitutional weaknesses, and because social roles differed for women and men, the consequences also differed according to gender. First, I will demonstrate how Mitchel distinguished between nervous men and nervous women using constructionist attitudes. Th en, I will discuss how his critique of three important agents of s ocialization, family, education, and labor provided a framework for understanding how white


76 American men who by every other metric were expected to be biologically programmed for success co uld be breaking down. mental states, Mitchell urged readers not only to sympathize with sickness, but to envision illness s most popular medical writing the neurasthenic man emerged: exhausted, down trodden, fraught with anxiety, and yet still confident in his constitutional superiority to women and non white men. Mitchell attended to the gendered pressures men and women fac ed and acknowledged these as determinist perspectives of his day. In fact, in Wear and Tear, Mitchell described the boys and fts, and of unlike physiological needs and 69 Famously, Mitchell argued women were inherently intellectually inferior to men. 70 mental equality of men. He di 71 As these comments suggest, Mitchell adhered to the core tenet of 19 th century medicine: social hierarchies reflected fundamental differences between races and sexes. However, Mitchell also believed in th e power of environment to shape an individual. And he believed that post industrial society placed new and harrowing pressures on people to work more productively in more confined for regular exercise and a healthy diet. Mitchell recognized that a combination of biological and social forces 69 Mitchell, Wear and Tear, 43. 70 Ibid. 71 Charles W Burr,. S. Weir Mitchell, Physician, Man of Science, Man of Letters, Man of Affairs ([Philadelphia]: The College, 1920): 27.


77 produce a sick or healthy person; such conditions could not be explained by constitutional failure alone. In Wear and Tear and Doctor and Pa tient, Mitchell described nervous illness as the result of an unfavorable environment. Many of the routes to health, he believed, lay within the control of the average person. Furthermore, he conceived of health broadly, naming physical and mental health to be fundamentally interconnected; he implied, through his descriptions of case studies that emotional health mattered significantly, too. In this chapter, I will use the phrase s to highlight the wa y Gilded Age physicians often conflated the two. 72 health demonstrated his view of the relationship between the mind and the body. He encouraged here is scarce a limit to the work you may get 73 He instruct ed 74 Because Mitch differently. If the environment made people sick, then different environments y ielded different results. 72 In the 1880s, the medical establishment had not yet decided how to engage emotions or think abo ut behaviors and experiences. Psychology and psychoanalysis would not find a broad audience until the early 20 th century, and would not become a fixture in American medical treatment until mid in th e 1880s, then, set him apart from his peers whose 19 th century goals focused more on measuring, quantifying, and classifying the body. 73 Mitchell, Wear and Tear, 20 21. 74 Ibid., 21.


78 Mi 75 learned, especially regarding emotional stability. In Doctor and Patient Mitchell argued parents instructed boys to withstand pain without emotional expressivenes s; this fostered adulthood traits of focus and self constraint With girls, however, were nervousness in adultho od. Mitchell blamed parents for the emotional weakness of the to endure pain and instead became 76 Thus, Mitchell believed parents trained girls into inferiority by failing to equip them with the tools to navigate professional worlds su ccessfully. What can be read as d constitutional inferiority I read as imp Mitchell believed parents soc ialized boys to succeed in public, professional worlds, but did do the same for girls. As a result, Mitchell believed it was not her more likely to become sick and distraught rather, no one taught her to be othe rwise. as a class, could never outperform men, as a class, he blamed parents for failing to recognize and cater to these differences. From this perspective, the offices and the pages of medical reports was a result of poor socialization and support for gender differences. Gendered socialization began in childhood. Mitchell censured common parenting habits for promoting ill health in children. Some of these were clearly connected to physical 75 Michell, Doctor and Patient, 104. 76 Ibid., 90.


79 development, such as 77 highlighted the hurts, the accidents, and the disorders or the 78 Mitchell found these to be powerful formative events, and gravely 79 In Mi s estimation, p arents responded to differently for girls than for boys. Parents assumed a girl child 80 She learned to emote freely, and her family environment reinforced the gendered perception that gi rls were frail and emotional. To boys, parents responded the opposite way. Mitchell recounted 81 Parents rep him. 82 Having learned similar things from their parents, other boys pressured one another to 83 Mitchell felt deep concern for boys who lacked basic emotional skills as a result of a stifling family environment. On one hand, this type of socialization acceptance. But it also raised boys without a language or a platform to address adult emotional 77 Mitchell, Wear and Te ar, 41. 78 Mitchell, Doctor and Patient, 84 5. 79 Ibid., 85. 80 Ibid. 81 Ibid. 83. 82 Ibid., 85. 83 Ibid.


80 did grapple with a range of emotions, yet they ha d learned at a young age to repress them. In play and physical activity, parents regulated their children in harmful gendered ways. Mitchell instructed: Train your girls physically, and up to the age of adolescence, as you train your boys. Too many moth ers make haste to recognize the sexual difference. To run, to climb, to swim, to ride, to play violent games, ought to be as natural to the girl as to the boy. All this is fast changing for us, and for the better. When I see young girls sweating from a good row or the tennis field, I know that it is preventative medicine. 84 His proscription affirmed two things: the inherent potential of all children, regardless of sex; and the relationship between unbounded physical activity and deny girls these activities would be to socialization of girls implied affirmation of the socialization of boys. If given the opportunity to play, exercise, and move about freely, Mitc hell believed, a child would be more likely to su stain good health later in life. And yet, parents typically offered these opportunities to boys. He wrote put on the gloves, and stand up with their brothers, and take gallantly t he harmless lows which are so valuable a training in endurance and self control. 85 But these no reason why the mass of [adult] women should not live their own 86 full of 84 Ibid., 141. 85 Ibid., 142. 86 Ibid.,144. The remainder of the sentence suggests that during menses, women may need to break from ordinary activity.


81 exercise and free choices laid a reliabl e foundation for a successful, fortified adulthood; confinement away from these things could bewitch anyone girl or boy with debilitated health later on. Mitchell believed t he education system perpetuated the negative impact of differential treatment begun in childhood. He found that 87 For girls and young women, the risk of overschooling loomed highest during puberty and menses. Without proper attention to these physically draining, yet essential features of a education could quickly become dangerously exhausting. Intense study during these crucial times, Mitchell and many Victorian physicians held, could damage a support to their students. such support for the intensity of their studies, and so most colleges left men to nav igate their health needs with the strain of college study on their own. So, for men, overschooling meant overexertion and extreme exhaustion. Mitchell related to this concept as he, in his early college years, performed poorly and struggled to graduate He wished to see colleges follow the model of Johns Hopkins, admirable exception, [where men receive d utmost value 88 In many ways, overwork potentially threatened the health of all students. Mitche ll called for keen attention to the ways in which college academics, sports and other endeavors did not He understood this to be than 87 Mitc hell, Wear and Tear, 63. 88 Ibid., 45.


82 a direct outcome of the process of schooling. Moder n education, like many factors of mo dern society, overtaxed students, physically and mentally. He also spoke generally about all students, 19 th century life. He 89 demonstrated diffe rent experience based on gender. Mitchell argued that a and upbringing determined how well equipped they were to withstand the pressure of post secondary education. Because c olleges presumed men would be capable, and so did not eve n recognize any n eed for testing or support. Mitchell told his readers this was medically unsustainable because crippled hopelessly oweing to the fact that no college pre examination of thei r state had taught them their true condition 90 This so Without tests to confirm physical aptitude, and without tools from childhood to express emotional experiences, men navigated their college year s alone. Gendered norms for manhood in the late 19 th century left men with no opportunity for fear, uncertainty, or failure. experiences as workers comprise significant sect ions of Wear and Tear and Doctor and Patient. As all proponents of neurasthenia in the late 19 th century contended, Mitchell viewed the disease as an outcome of modernization. Work hours dragged on, and economic security seemed out of reach or short live d at best. The urban, industrial world simultaneously promised white, 89 Ibid., 59. 90 Ibid., 65.


83 American men they stood at the helm of the future, and inherited God given and scientifically proven superiority over all others. And yet, the crumpled under the pressure of their prof essional combination [of anxiety with physical and mental overwork] is sometimes fatal to the health of 91 While he spoke of treating greater numbers of neurasthenic women, men most likely candidate for neurasthenia. 92 The intensity and focus scientific work demanded of its men often drove them into debilitati ng cases of brain tire. Businessmen also faced health challenges as a result of their work demands. Mitchell recounted: The worst instances to be met with are among young men suddenly cast into business positions involving weighty responsibility. I ca n recall several cases of men under or just over twenty one who have lost health while attempting to carry the responsibilities of great manufactories. Excited and stimulated by the pride of such a charge, they have worked with a certain exal ta tion of bra in, and achieving success, have been stricken down in the moment of triumph. This too frequent practice of immature men going into business, especially with borrowed capital, is serious evil. The same person, gradually trained to be naturally and slowl y increasing burdens would have been sure of a healthy success. 93 Two points are notable here. First, the most severe cases of neurasthenia occur among business unready for the high stakes and fa st pace of the business world. Mitchell believed that in due time, with proper guidance, one could learn the trade and enjoy success. But without that, men likely flailed under the pressure of their environment. 91 Mitchell, Doctor and Patient, 123. 92 Mitchell, Wear and Tear, 62. 93 Ibid., 63.


84 Another aspect of paid labor which disp roportionately afflicted men w as working conditions. White, middle and working class men in cities languished fro ate hours of work, irregular meals bolted in haste away from home, the want of holidays and pursuits outside of business, and the constant practice of carrying home, as the only subject of talk, the cares and successes of the counting house and the stock 94 consumed men entirely, and even time away from it never afforded men a genuine break. Suggesting that men who discussed this matter with him felt a sense of shame or guilt, Mitchell they had worked every day, often travelling at night or on Sunday s to save time, and that in all 95 Not o nly were men unprepared for the nature of their jobs but the non stop schedule exhausted them. roles of provider and breadwinn er to be fraught with intensity unlike any other. Harming the 96 To Is it a wonder if asylums for the insane gape for such men ? 97 Because Mitchell blamed poor health, he promoted sympathy and respect for patients as models for successful care. Even 94 Ibid., 64. 95 d by work. Rather, indicated a middle class perception of women. Surely many women toiled for 20 hours in factories like the men he wrote a 96 Ibid. 97 Ibid., 64 5.


85 lessened 98 He defended the nervous patient especially the nervous woman relationships with husbands, so much is born out of that which healthfully dealt with, or 99 In other words, that which plagued sick women was not a product of an essential ineptitude; rather, people developed nervous disease because of a constell ation of unfortunate circumstances. Mitchell believed individuals should not be casted off because of their neurasthenia they should be helped. 100 help them by educating them. Too often, nervous patients lacked concrete understanding of their condition which only exacerbated the symptoms. This problem potentially plagued an accurately diagnose a child for fear of alienating his parents. Mitchell argued more flattering to his patrons to say that the child has broken down from overwork than from the 101 Polite physicians danced around th e real causes in their diagnoses to hoices. 102 Thus some physicians could not be trusted, and 98 Mitchell, Doctor and Patient, 10 11. 99 Ibid., 11. 100 Known for its progressive almshouses and asylums, Philadelphian medical professionals led the trend toward humanizing patients deemed insane. See Nancy Tomes, The Art of Asylum Keeping: Thomas Story Kirkbride and the Origins of American Psychiatry (Philadelphia: Un iversity of Pennsylvania Press, 1994). 101 Mitchell, Wear and Tear, 41. 102 Mitchell, Doctor and Patient, 45.


86 especially not with the vulnerable, innermost fears of breakdown and failure that white, middle and working class patriarchs exper ienced in the late 19 th century. Mitchell knew patients felt overwhelmed by the potential number of doctors, treatments, and remedies available to them and so he highlighted 103 While by the end of the century, professionalizatio n, the training standards set out by the American Medical Association, and literary representation presented the doctor as a skilled, static figure who bestowed objective practice onto his patients, Mitchell rejected this characterization. Especially rega rding the obtuse and slippery nature of a disease like neurasthenia, a singular, fixed scientific definition was impossible. The treatment of nervous diseases required flexibility, attention to context, and a subjective, individualized approach. Not one to sacrifice the authority of science, Mitchell took a literary approach to nervous disease: he reminded his audiences contradictions in real life 104 which precluded a clear standard for nervous disease. Mitchell wished more dynamic portrayals of doctors existed in literature to humanize the profession. In nineteenth century literature, he noted, doctors appeared as one dimensional figures, called into cure a sick character, but never developed further. In reality, Mitchell proffered, physicia 105 Mitchell himself modeled this; by 1880, the public learned not Mitchell not only as a physician but also as a talented fiction writer. 106 Like the neurasthenic patient, doctors abide d complex experiences they were complicated, fallible humans like anyone else. He called for a 103 This dissertation shows men received ca utionary information about doctors from other sources too: YMCA medical talks and news media. 104 Mitchell, Doctor and Patient, 69. 105 Ibid., 76. 106 W. J. New York Times, Nov. 30, 1901.


87 honest, dutiful story of an intelligent, thoughtful, every relate and open their most vulnerable inner lives. 107 In D octor and Patient, Mitchell transfigured the medical interaction into a friendly encounter between collaborators. By posing the doctor as a human, relatable character himself susceptible to nervous illness and emotional unbalance Mitchell encouraged the patient to bare his true self. As sympathy became part of the doctor patient dynamic, the interaction in the clinic became less about a professional consultation and more about two me n talking over shared experienc es. Mitchell facilitated a trusting r elationship by describing the doctor patient relationship in religious terms. In a tender moment of self reflection in Doctor and Patient, Mitchell described and foibles of to day, 108 As a confessor, the physician listened truly attended to the experiences of the patient. [only ] a patient to of a whole life, its far 109 Mitchell suggested patients approached their physicians with similar potential for intimacy and candor as they would their minister. In fact, Mitchell intimated that a physician would be even more useful because he medical and religious confidant s emphasized a requirement trustworthiness inherent in ea ch vocation. Mitchell insisted the physic i 107 Mitchell, Doctor and Patient, 80. 108 Ibid., 43. 109 Ibid.,10.


88 110 of neurasthenia involved sexual performance or bitter anxiety, the assurance that doctors we re relatable, attentive, and trustworthy encouraged them it was safe to seek treatment. Wear and Tear and Doctor and Patient coded its quotidian symptoms with manly legitimacy. Many of the examples Mitchell referred to involved men in prestigious positions. As mentioned earlier, nervous illness happened to scientists, brainworkers, and breadwinners of all varieties. Other candidates included manufacturers, railway officials, brokers, clergy, and la wyers. 111 E xhaustion affected brainworkers differently. For example, a medical scholar engaged in three hours of intense brainwork a day and suffered debilitating fatigue. A only got brain tire after extended p eriods of concentration. 112 Mitchell explained these varied cases to show brain tire was difficult to identify: it was easily mistaken for other problems, it revealed itself only after it was too lat e, and it affected individuals differently. Furthermore, it did not only happen upon brainworkers but to anyone who overused his brain. Virtually anyone with digestive symptoms or disrupted sleep could have been a candidate for nervous disorder. bout with neurasthenia One does not escape from being 113 No man, it seemed, was immune from the reach of nervous illness. In fact, as Mitchell told it, all of the gendered expectations for men specifically white, urban men contribute d to the likelihood of disease. Those who occupied 110 Ibid., 43. 111 Mitchell, Wear and Tear, 63. 112 Ibid., 16 18. 113 Ibid., 58.


89 prestigious professional positions were white men; those who were beleaguered by stressors of depicted with respectful sympathy that white men across social class lines were breaking down. facing writing effectively expanded definitions of late ninete enth century white manhood to include precarious mental and physical health. Mitchell believed that the public got most of their views about doctors, health, and illness by reading about it and so the accessibility and popularity of his lay medical literature reflected his intentions to sway public opinion. 114 He drew from personal experience to refa shion th eir perception of nervous men. Civil War in which he witnessed many patients suffer emotional trauma, disillusionment, and grief as a result of the horrors of the war. Less violent but nonetheless traumatic events could 115 Mitchell recounted an incident when he s headaches. 116 Sometimes the impact accrued more gradually as a result of prolonged wear on the mind and bo dy. For men, financial demands bore down healthy men into nervous patients. Just as environmental factors generated nervous illness, changes in environment provided cures. The final section of Doctor and Patient built upon the standard rest cur e to inc lude 114 In Doctor and Patient, he criticized the growing tre nd in literature toward realistically portraying gruesome experiences of illness and death threatened to convince readers they knew science (69 73). 115 Mitchell, Doctor and Patient, 121. 116 Ibid.


90 spending time in the rugged outdoors. Sometimes called the West Cure or the camp cure, Though addressed to sum mer fishing trips with his dear friend, Phillips Brooks. It idealized a properly masculine way of life as mentally and physically stabilizing for anyone who participated. The cure for nervousness did not address women as women, but aimed to restor e nervous patients women or men to a lifestyle that promoted health and rigor. keen to point out this type of remedy was available to those of aver age means as well. He instructed 117 The camp cure was not only for women or for the wealthy ; here he generalize d the positive 118 Once again he used the specific case study of a woman to intro duce nervous illness but applied the remedy to all sufferers including men. While boy s may have learned camping skills in childhood more rea dily than girls, Mitchell granted 119 He assure alleviate d the house 120 These activities steel ed the body against ill ness when the camping trip even after the camper returned to breathing stagnant indoor 117 Ibid., 158. 118 Ibid. 119 Ibid., 160. 120 Ibid., 161.


91 air at home. More importantly, their efficacy crossed class differences, thereby making a form of this treatment available to men of all white, nervous men who sought it out. He concludes Doctor and Patient tempt others to try each in their way to do what has been for me since boyhood a cons tant 121 No longer pledging the physiological gulf between women and men or the fundamental difference between doctor and patient th applied to anyone potentially everyone who toiled under modern worki ng conditions In fact, he reveals his own illness and recovery to be the ro ot of his professional opinions Combined with the cases of Civil War soldiers and his friends in brain working professions ted that even the most successful men as men broke down. He defined late nineteenth century manhood as inherently subject to nervous illness precisely because it required men to overburden themselves with professional and familial responsibility. Neurast henia, then, was a symbol not of weakness, but of achievement an unintended byproduct of the high expectations for white manhood in a modern, urban America. Conclusion person. 121 Ibid., 1 77.


92 122 Another friend, Beverly Tucker wrote a lon ger biography 1914. 123 She intended for l iterary and medical luminary with a devoted attention to the well being of his mentees and patients. the history of neurasthenia. They provide new insight into Mitchel gender, specifically that Mit c h ell cared deeply about the physical, mental, and emotional well being of men. While the historiography about Mitchell too often dwells on his chauvinism, I argue Mitchell spoke candidly and sympatheticall y about the perils of late nineteenth century gender roles for white men. Moreover, he enjoyed a favorable reputation among colleagues and the public; as a physician as a fiction writer. His writing demonstrated he was keenly aware of himself on all of t hese levels. Notably, he used narrative to educate the public about nervousness, and he leveraged his prestige to destigmatize the men who suffered from it. His popular medical writing helped individual men resolve the contradiction between the constitut ional superiority they believed characterized their white manhood and the debilitating weakness they experienced; the rhetoric of neurasthenia reconciled this contradiction. 122 Guy Hinsdale, S. Weir Mitchell (Philadelphia: J.B. Lippincott Co, 1902): 3. 123 Beverley R. Tucker, S. Weir Mitchell; a Brief Sketch of His Life with Personal Recollections (Boston: Badger, 1914): 8.


93 ations about white manhood in the 1880s and 1890s. Other doctors followed him, especially those who Infirmary for N ervous Diseases in Philadelphia. While S. Weir Mitchell and George Beard do minated the medical conversation about neurasthenia, physicians across the country engaged and replicated their elite, non urban about neurasthenia into their small town clinics. They embraced the sympathetic approach. According to Gosling, non elite physicia ns n d 124 T prestigious posts at northern hospitals and universities and their colleagues in family clinics in rural Southern and Western towns. Additionally, a dvertisements and organizations such as the YMCA also recognized the uncertainty and vulnerability men felt, and offered confidential solutions as well. White, working men began to envision manhood and nervousness not as mutually exclusive, but necessarily constitutive. They became more likely to identify with their fears and vulnerabilities, and to see nervousness not as a signal of inherent weakness, but of affirmation that their environment stressed them so precisely because they were superior to women and non white men. The subsequent chap ters of this dissertation will show how neurasthenic manhood normalized weakness and breakdown as a quintessential part of white manhood. 124 F.G. Gosling, Before Freud (Chicago: University of Illinois Press, 1987): 129.


94 CHAPTER 4 LESSONS FROM THE YMCA ABOUT SEXUAL HEALTH 1879 1900 Introductio n and 1890s. These exclusive events stood out amid the mostly co ed social and educational programs the YMCA hosted. The pamphlets contained information about upcoming M edical Talks regarding sexual health and nervousness. This type of p romotional literature and the lecture s they advertised highlighted a and emotional health. I argue that YMCA activity in the Gilded Age embraced th e language of neurasthenia to achieve its goals of social reform among white, urban men. Scholarship acknowledges that the New York Association stood at the helm of post bellum development of the global YMCA. Tasked with the objective of impressing upon men a moral responsibility suited to changing social mores of the period, the New York Association led the YMCA in carefully curating educational programs and social support systems to provide a safe alternative to the licentiousness in the streets. This chapter argues that the YMCA the cultural and medical value of neurasthenia rhetoric to advance its own modernization process, to promote its brand of social purity, and to teach men to mitigate sexual and emotional distress. The YMCA led the charge of urban reform since the mid nineteenth century. Determined to promote a climate of virtue and manly prosperity within an industrialized society, YMCA branches offered a Christian haven. For white, middle and working class men in American cities, time clo cks stamped out their dignity, mechanized labor trounced their vigor, and factory managers cu rtailed their autonomy. As Anthony Rotundo observed, industrialization squashed t ypical routes to self made manhood, and urban men found bodily pleasures of


95 drink ing, boxing, sex, and carousing with others highly seductive. 1 Yet all of these options threatened the health physical and mental of men in cities. In response, the YMCA Christian theology 2 These goals coincided with those of S. Weir Mitchell, George Beard, and physicians nineteenth century: in fact, the YMCA adopted the rhetoric of neurasthenia and solicited phys Age by bringing medical information about sexual dysfunction and nervousness to men most likely to suffer the se conditions. Through Medical Talks and other health programs, the YMCA recognized the authority of the physician; the religious perspective complemented the medical one, but did not supersede it. As a result, the YMCA became a prominent site for transm ission of information about sexual neurasthenia. The YMCA blended the evangelical tradition of personal testimony with contemporary medical expertise. Together, these resources offered routes to salvation for individual men and as well as social order for a blighted nation. Medical Talks gathered men together in the spirit of positive reeducation to inspire virtuous camaraderie among men. In general, t he YMCA promoted a deep personal bond between two men, forming pairs in which the two could engage in 3 In 1889, Samuel Sayford outlined the 1 Anthony Rotundo, American Manhood: Transformations in Masculinity from the Revolution to the Modern Era ( New York: Basic Books, 1993). 2 YMCA leaders rejected the core tenets of social Darwinism, which viewed social stratific ation as an inevitable outcome of racial and ethnic superiority. Just as vice could be spread, so could chastity. 3 Sayford, Samuel M. Personal work (YMCA International Committee, 1899).


96 YMCA International Committee publications with Scripture to define personal work as the bes t way to spread Christianity through friendship between men. Sayford looked to universities, fraternities, and literary societies, and saw the most successful examples of these shared an emphasis on 4 From the YMCA perspective, a man could best reach his wayward brother and steer him into a chaste life by establishing a loving bond with him Within this context, Medical Talks excluded women to foster a space for men to explore their sexual and emotional hea lth. 5 This chapter will show that YMCA leaders and educators insisted the best remedy to cultures that promoted un chaste manliness was to create alternative social spaces where manliness coincided with virtue and sexual purity. To understand the specific conditions within which the YMCA became a n important consider two concurrent trends: the Purity movement affiliated with YMCA and charged by Anthony Comstock, and the deliberat e effort made by the YMCA to refashion itself as a modern bureaucracy instead of a religious institution. Both of these trends intersect at the subject of this chapter: the medical moral education the YMCA offered to men to help them avoid sexual debility and nervousness. When one of the key figures at the New York Association, Secretary Robert McBurney, fell victim to neurasthenia the YMCA seized upon the opportunity to educate young men about t he threats of sexual debility, neurasthenia, and related di seases The first half of this chapter outlines the historical context the YMCA. The second half of the chapter takes a 4 Ibid., 18. 5 As Chapter Six will argue, the clinic was anot her similarly protected space for men to disclose their intimate sexual and emotional concerns.


97 1880s and 1890s. More specifically, this c hapter shows that the YMCA used medical experts and neurasthenia rhetoric to refashion its moral messages through a more modern, scientific lens. By the end of the nineteen th century, the YMCA advanced a medical morality, which disseminated medical infor mation to young, white, middle class men about the parameters of healthy, manly sexuality. A key contention of this dissertation is that the rhetoric of neurasthenia circumscribed whiteness across class lines; the findings presented in this chapter demonst rate the YMCA was no exception. While the YMCA established independent branches for black and native men, these lacked the sophistication and reach of the services offered to whites. When men gathered in the Association Hall in New York, or in smaller br anches across the country, they engaged in white manhood through intimacy and education on white men, to the exclusion of all others. Because the YMCA included men of different class backgrounds in shared space, I argue that the blending of neurasthenia rhetoric with YMCA social reform effort worked to homogenize white manhood across class lines. 6 Perhaps a more accurate interpretation of the Medical Talk pamphlet cove Comstock Anti Vice and early YMCA Medical Talks The twinkling optimism that the YMCA could transform white sexual and emotional health resounded with a wave of social movements in the Gilded Age Many reformers, mostl y of middle class WASPS, felt responsible to remedy the ailing conditions produced by modern, urban American life. Moralists advocated for temperance, vice reform, 6 Chapter Six will argue the clinic performed the same work.


98 and improved conditions for the poor. 7 New Thought enthusiasts empowered individuals to r aise themselves out of dreadful circumstances, and progressive reformers believed favorable environments positively affected the work ethic and moral standard of a community. 8 Even medical experts wrote books to educate the public about lay medical treatm ents they could This milieu motivated Anthony Comstock to wage war on the vice and the YMCA to educate men on the dangers of non marital sex. Anthony Comstock began hi s campaign against obscenity in February 1866. He encouraged people to mail him obscene materials they came across. The Society for Suppression of Vice, led by Comstock, maintained its headquarters in Poughkeepsie between 1870 and 1875. The group reloc ated to New York in 1875. Society Reports detailed arrests, convictions, and confiscations of lascivious material. The reports itemized the various types of printed materials they 9 cene pict 10 In addition to eradicating themselves as doctors to treat female diseases, and who cond uct their traffic partly through the 7 See Christine Stansell. City of Women: Sex and Class in New York 1789 1860 (Urbana: University of Illinois Press, 1987, 1982); Nicola Kay Beisel, Imperiled Innocents: Anthony Comstock and Family Reproduction in Victorian America (Princeton, N.J.: Princeton University Press, 1997); Donna Dennis, Licentious Gotham: Erotic Publishing and Its Prosecuti on in Nineteenth Century New York (Cambridge, Mass: Harvard University Press, 2009). 8 He believed his railroad workers would abstain from vices such as gambling and drinking if they had bucolic living environments and economic stability. 9 Minnesota Libraries, Kautz Family YMCA Archives. 10 Ibid.


99 these men abortionists, and called for their arrest. T mentioned abortion But t he them e of imposter doctors, or quacks, did concern many of the YMCA invited speakers. In the late 19 th century, sexual information, and medical responses to it, could be readily located in print media. The Vice Committee affiliated with the YMCA, and both bel ieved in the power of lascivious ideas to cause lascivious actions in men and women. While Comstock sought to eradicate th is type of seductive material, early YMCA leaders worked to counteract prurience with a formal (re)education about sex They offer ed seminars about the dangers of sex in scientific, detached terms. In 1870, the YMCA New York Association announced it would hold two four part lecture series about medicine on Friday Evenings. Prof. Austin Flint Jr. M.D., a profe ssor at Bellevue Medic al Colle ge gave the December course, and Rev. John Hall D. D. gave the January 1871 course. Dr. Flint carried a reputation for outstanding work in physiology, public institutions, and diet. The lecture series reflected popular medical themes of the perio d: general physiology, blood, nutrition, and the nervous system. permanent courses of Scientific and Literary lectures which will fully equal the best of those delivered in other cities, 11 Another similarly clinical education opportunity came from an 1871 pamphlet entitled of the City of New center of the page Without signaling a specific name, the cover denoted an aggregate authority of the medical profession. T he pamphlet purported to give readers important medical inf ormation 11

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100 about health and well being and caution men against masturbation. Two paragraphs on the young men brought their shameful questions to strangers, such as officers of the YMCA. To help the information about masturbation, also called self pollution and self abuse in this document, organizers encouraged men to ci rculate this pamphlet to their friends in secret 12 The title of the medical talk appeared on page three Abuse: Its Evils and their attitu des immediately following the Civil W ar that equated the masturbation with sin. In fact, as the opening line stated, self vice material of its day, the YMCA publications of the 1870s combined moral and medical messages to portray masturbation as a physically damaging, reprehensible act of weak will and religious disregard. Often, they believed, men inadvertently uncovered the perils of mastu 13 The Society for the Suppression of Vice continued to operate concurrently along the YMCA and effectively destroyed and censored publications i nto the 20 th century. Notably, the Comstock Law 1879. This law prohibited the transmission sexual information of any kind 12 13 Ibid.

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101 through the U.S. Postal Service. 14 Abs tinence and self denial remained tenets of YMCA manly ideals. However, in 1879, the focus shifted when quintessential urban disease struck top YMCA leadership : neurasthenia The Rise of the Nervous Bureaucracy: The New York Branch of the YMCA Secretary R obert McBurney figured centrally in the development of the modern identity of the post Civil War New York Association. Earlier YMCA organizations in the U.S. followed the British model introduced a t ers, mostly clerks, and revolved around evangelical ideals of integrity and religiosity. 15 However, the Civil War prompted the organization to refashion itself dramatically. Partly recovering from the death of so many members during the war, and partly due to financial pressures to commercialize, the post Civil War YMCA moved away from the voluntary basis and solicited new, capitalist leadership. This included powerhouses such as William E. Dodge and J.P. Morgan. For these men, the YMCA provided a place t o exercise their charity, but it also quickly became a place through which to spread bureaucracy. The YMCA in the late 1860s adopted a business model; it dismantled volunteer led leadership groups and appointed a single leader for planning and organizing: Robert McBurney. The embodiment of the new direction of the YMCA, McBurney combined evangelical goals with business capabilities. A wealthy 14 For the impact of th e Comstock law on abortion practices and accessibility, see Leslie J. Reagan, When Abortion Was a Crime: Women, Medicine, and Law in the United States, 1867 1973 (Berkeley: University of California Press, 1997). 15 For more on antebellum YMCA activity, see Helen Lefkowitz Horowitz, Rereading Sex: Battles Over Sexual Knowledge and Suppression in Nineteenth Century America (New York: Knopf, 2002), Chapter 13.

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102 businessman himself, McBurney exemplified the future masculine ideal of the YMCA: the sensitive, yet effective en trepreneur. 16 This late 19 th centruy revamped identity required a matching headquarters building that demonstrates the deliberate attention the new leadership invested into the New York Association building on the corner of Fourth Avenue and Twenty Third Street. Completed in 1869, the building spanned 300 feet along Twenty Third Street, boasted five stories, and drew attention to its public auditorium through a central dome entrance. Compared to nearby churches, the YMCA building appeared notably secular. It featured Second Empire style, which according to Lupkin, connoted a business like masculinity and stability. To nod to its religious affiliations, it included some Goth ic details. In contrast to nearby churches, the new YMCA building appeared stately and secular; its bourgeoning identification with commerce could be observed from the streets. 17 Storefronts advertised wares for sale and beckoned customers inside to see a rtist studios and gallery spaces upstairs. Membership dues covered the costs of the lectures as well as a number of other features. For nonmembers, tickets cost fifty cents for one course, or $3 for an entire series. Doors to the association hall opene d at 7:15 for events, and the lectures began at 8. 18 Upon entering the YMCA building, visitors possessing a ticket or arriving for a meeting went up the main stairway toward the Association Hall. They could also enter the hall directly through a smaller en trance. The Association Hall was a large, long room that invoked a feeling 16 Paula Lupkin, Manhood Factories: YMCA Architecture and the Making of Modern Urban Culture (Minneapol is: University of Minnesota Press, 2010): 1 32. 17 Ibid., 46 49. 18

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103 the main level or take a seat in raised side galleries. Ornate ceilings and a b ox that shadowed the stage called to mind a contemporary worship space. The space was bright and dramatic, decorated with swirling iron columns. On the second floor, off the main staircase, lay the rooms. Men greeted newcomers there with formal postur e and professional gentility. Members accessed the parlors for conversation, or ventured to the third floor to the library and lecture room. The library contained 12,000 books and the reading room circulated 400 papers and magazines. The literary societ occurred the second Monday of each month. Members could bring a lady date and admission for both was free. They enjoyed a variety of activities at these receptions including readings, music and exhibits. 19 They also visited the gymnasium, located underneath the Association Hall where men engaged in Swedish gymnastics and strengthening activities. Men congregated in parlors that were exclusive to me n. 20 The YMCA welcomed all young men, but membership required a certification of good moral character. To gain membership be a member. However, the organization wished to make it clear they were open and welcoming to guests and members, especially those who were in trouble. On YMCA pamphlet reached out to the public: cordially invited to call on the Secretary, 19 University of Minnesota Libraries, Kautz Family YMCA Archives. 20 Paula Lupkin, Manhood Factories, 50 72.

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104 21 This service functioned as an informal, individualized method to reach men in need. It also meant that Secretary McBurney was a very busy man a point person for nearly everyone who came through the doors at the New York Association. While the YMCA branch stood as a leader and functioned often like a headquarters, individual YMCA branches throughout the United States functioned independently. Local associations functio ned as organized bureaucracies: they were not governed by a single higher authority and were free to decide the best course of action for its members and larger community. However, the New York Association served an important symbolic leadership role, and a material one. It produced many of the pamphlets and reading materials and made them available for smaller branches to purchase. Not all of them did, and not all of th em purchased every publication. This meant that the YMCA message was not always consistent or precise. Nonetheless, other branches looked to New York for guidance, bought the materials when they could, and often followed their example. So, while the endea vors of the New York Branch cannot be generalized to all YMCAs in the country, it can tell reveal a fair amount of information about dominant themes and values espoused by the organization. 22 The New York Association building was a success. Future planni ng for similar buildings on Main Streets all over the U.S. follow ed this model. The post bellum YMCA had an identifiable home base for its new agenda to not only perform evangelical duties but to shape the concept of manhood in the 19 th century. 21 of Minnesota Libraries, Kautz Family Y MCA Archives. 22 This information came from a conversation with Ryan Bean, archivist at the Kautz Family YMCA archives at the University of Minnesota.

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105 Neurasth enia became an important health concern for YMCA leadership when beloved Secretary McBurney fell ill in July 1879. The monthly newsletter featured his health story on the front page, prominently placed at the top: th of July, which were exceptionally heavy, he felt prostrated and unfit for work for several days, and was finally persuaded to go int o the country for perfect rest. 23 The immediacy of his illness worried his friends. To recover from what appeared to be a bout of neurasthenia, McBurney left New York with two of his colleagues to Raquette Lake in the 24 ment resembled S. Weir nature to eradicate the perils of overwork. 25 YMCA members likely knew about the West Cur e from other sources because medical and popular publi cations routinely covered it It also featured in the previous monthly newsletter, in a report from Colorado from Dr. Bennett. While my camp fire solitary and alone when need required, and sleep on the ground under the stars. 26 The fresh air and rugged environment of Colorado rejuvenated his health. The West Cure succeeded for Dr. Bennett, and YMCA readers read all about it. 23 24 Ibid 25 Literary scholars argue the West Cure was the male version of the rest cure. Barbara Will made a compelling and 1880s, men imagined themsel ves as muscular heroes, invigorated by the fresh air and rugged landscape. 26

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106 Friends of Robert McBurney worried about his condition but hoped this West Cure would help him in the same way. The August monthly newsletter joyfully announced that due to he was saved from a threatened sickness. We are all thankful that he seems now on 27 neurasthenia and the prominent newsletter coverage it received demonstrated the YMCA recognized nervous illness as a grave and alarm ing threat to hard which being. By 1879, the YMCA had become a vehicle for spreading awareness about the causes and cures of neurasthenia and nervous diseases. as McBurney suffered with nervousness, so did the Secretary of the Brooklyn Association, H. B. Chamberlin. The mont his recovery contained strained optimism that he would be able to recover. The newsletter Thousand Islands in the St. Lawrence, may be the means of saving him from what has been 28 In other words, neurasthenia bore severe consequences, and could take down even the most powerful, successful men. The New York YMCA needed to take the illness seriously because it seemed the fast pace of the modern American city had the potential to devastate any man. 27 Ibid. 28 Ibid.

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107 Private corresponde nce among YMCA secretaries discussed the perils of overwork as well. In one letter, R. C. Morse bemoaned the frail health of secretaries who frequently buckled under the strain of their positions. In fact, many YMCA leaders wrote about suffering nervous b reakdowns. John Donald Gustav early post 29 Gustav Wrathall analyzes the actions of McBurney, Robert Weidens all, and other secretaries who routinely wrote of overwork through the lens of Protestant ascetism. As a result, the analysis portrays these secretaries as if they were clinging to the Protestant origins of the YMCA, eager to retain the pietism of self denial and grueling physical labor that characterized their evangelical beliefs. h nervous illness painted a much different picture. While the YMCA Association Notes publication resp illness within the broader cultural context of neurasthenia: mo dern life demanded extensive work hours indoors and the overstimulation eventually broke a man down. McBurney, who served as the face of the YMCA, waiting around the clock to meet with distressed young men off the streets of New York, prepared to counsel them about morality and Christian faith, certainly spent more time working than not working. The newsletters recognized the double edged sword of the intensity of the Secretary position. They valorized the commitment and dedication McBurney and Chamberli n offered to 29 John Donald Gustav Wrathall. Take the Young Stranger by the Hand: Same Sex Relations and the YMCA (Chicago: University of Chicago, 1998): 16.

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108 their vocation. However, they recognized the hard work required of Branch Secretaries had driven these men into nervous states. The threats to their health were so dire, they had to remove themselves completely from their work responsibilit ies and seek restoration in nature. time: Mr. McBurney and Mr. Chamberlin are not men who have recently taken up Association work; they have devoted their lives an d energies to the work for young men. They have had an experience of years in which to study the work and practically to get habituated to its peculiar phases and requirements. Yet in the midst of that work and in th e best days of their lives, they both came dangerously near such an illness as might have permanently unfitted them for further usefulness. We desire to make remarks such as these: to be at the Rooms day and night seven days of the week, sympathizing wit h young men in their temporal and spiritual affairs and to has his heart enlisted: such labor cannot be maintained effectively and enduringly without timely and frequ ent and adequate rest; such rest should be an appointed part of a should be religiously observed. 30 medical practices into the intellec tual and spiritual pursuits of their members. While Association Secretaries privately celebrated the sacrifices they made in their professional live s in service of their religion, the YMCA publicly treated nervous illness with a medical perspective. The piety remained in private and the public view fused the YMCA goals of health and well being with contemporary medical treatment sanctioned by the leading McBurney an importance of staving off nervous illness. That summer, the Association held five Open Air Meetings and encouraged men to breathe deeply and exercise the lungs by singing together 30

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109 du ring the meeting. The New York branch scheduled a lecture series for December 5, 1879 by be instructional as well as humorous on the topic of what a man could fin d if he takes up the urge to venture westward. One reviewer, Mr. H. Thane Miller, former president of the National 31 Ford to ured widely promoting the value of Westward travel on the heartiness of the American man. The first official Medical talk was held on March 5, 1880. Additionally, the association facilitated a group of 34 medical students who met on 32 Clearly, the YMCA viewed neurasthenia so much so they rallied around them with the intention to prevent men from becoming ill altogether. As subsequent section s of this chapter will show, their interest in sexual purity fused with medical information to help educate men about their sexual health. They believed proper information could adequately dissuade men from engaging in impure activities that would damage their health. direct approach to helping them gain access to medical care. The Institute opened a Medical Benefit Club in fall of 1887, and it drew 100 members in its fir st year. Members paid a 33 fund to help supply healthcare to young men. Men could make small deposits at the Institute to accrue a savings account. When he reached a 31 Ibid. 32 Kautz Family YMCA Archives. 33 YMCA Of New York Annual Report, 1889. University of Minnesota Libraries, Kautz Family YMCA Archives. p. 84.

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110 Bank. By 1889, 100 men had taken advantage of this deal and opened accounts. Collectively they saved $14 00. 34 While not all YMCA branches kept trained physicians on staff, the New YMCA to ensure the moral standing of their young men, they also needed to bolster their phys ical health. In concert with leading neurological findings of the late 19 th century, YMCA leaders believed a healthy body and a moral mind were mutually constitutive. Both Secretaries eventually recover ed McBurney had not returned t o his post by Sept ember, though the newsletter delighted in congratulating the Secretary on his improved Chamberlin was a bit slower to recover, but the September report contained o ptimism that he 35 As chapters three showed, m edia frenzy about the declining health of American men likely underpinned the concerns of the YMCA leadership, but the high profile of McB urney and demonstrated that the YMCA took neurasthenia seriously. I argue that the YMCA worked in concert with the dominant tenets of popular neurasthenia rhetoric : it operated under the assumption that too much work resu lted in illness; and it valued holistic well being as both mental and physical, with an emphasis on the choices and behavior of men -the discourse about the n eurasthenic nation played an important part in the ways in which the YMCA approached health in the final two decades of the twentieth century. 34 Ibid. 35

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111 The YMCA alleviated some of the p sychic and social alienation endemic to city life in the Gilded Age. T.J. Jacks th century listlessness and emotional vacancy that resulted from rationalization and mechanization of daily life. y to actual 36 Instead, an industrial economy spurred along, and men could choose to either spur along with it or be left behind. Lears believed this vacuous inner life caused neurasthenia. By the end of the 19 th century, the industria lized economy transformed the workforce into a sea of faceless mechanized laborers. For men specifically white, Protestant men who were or aspired to be middle class feelings of disconnect from professional pride only exacerbated the problem. White Ameri can men in the Gilded Age felt increasingly isolated from his family and sense of individual value. 37 YMCA leaders believed these conditions led men to seek out troublesome company in gambling halls and boisterous saloons. Seduced by the instant gratifica tion and bodily pleasure these spaces offered, men many unmarried bachelors, congregated there. self pollution or could positively compel him toward a l ife of virtue. This belief found wide support among a variety reformers in the late 19 th century who believed poor behavior and immorality stemmed from environmental influence. Jane Addams and George Pullman, for example, structured environments in whic h workers could enjoy respectable living conditions, 36 Jac kson T.J. Lears, No Place of Grace: Antimodernism and the Transformation of American Culture (Pantheon Books: New York, 1981): 18. 37 Rotundo, American Manhood, 170 175.

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112 access to reading materials, and clean water and food. They believed environmental integrity inspired individual integrity. YMCA rhetoric in the 1880s and 1890s celebrated a community that held men ac countable to one another for high standards of manly purity. The YMCA set high standards for manliness including physical fitness, intellectual acuity, devotion to Christ, and sexual propriety. Boxing, gambling, drinking, and running with women could cer tainly bolster a white steadfast, faithful manhood that demanded men respect women and themselves so much they refused to engage in sexual contact with them until marria ge. This was a tall order because it asked men to withstand peer pressure and temptation, which for New Yorkers, was readily present and accessible, and opt for chastity instead. Most of the YMCA social events welcomed women, so it was notable and delib erate when an event excluded them. Interestingly, the formal and regularly scheduled medical lectures co ed talks on various topics beginning in March 1880. 38 The New York Association circulated small pamphlets listing the titles and speakers of upcoming lectures. The front of a plain, single the titles and events should be kept secret from women. Inside the pamphlet extended the invitation to all men, regardless of economic circumstance. They emphasized this using italicized text indicating all men were welcome to attend the medical talks thus extending the invite to poor non members. Some of the talks were pragmatic medical information, such as Dr. T. E. 38 University of Minnesota Libraries, Kautz Family YMCA Archives.

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113 t he lecturers possessed an M.D., granting an air of medical legitimacy to the talks. The fact that the Association only permitted men to attend appeared three times on the brief document, which signaled that whatever the important information was, it would be much different from the debates and literary discussions, or the social engagements, to which women were welcome. friendship with one another could be as harmful as help ful. In an 1889 speech sponsored by the Social Purity Branch of the Manchester YMCA, Reverend The Earl of Musgrave spoke about this to an audience of men of all ages. He explained that a real man might find himself alone in the pursuit of manhood because it was so difficult an endeavor that men may have to carve their denial and suffering but this may cost him. The fallout for doing the right thing could include losing personal friends and than manly men who readily capitulated to their desires. However, the Reverend Earl of Musgrave assured the audience their role model for manly behavior was Jesus. 39 To embrace the way of Jesus, a man must disengage from the sexual opportunities society offered him, which the Earl Men achieved manliness only 40 While the talk portrayed manliness as a lonely pursuit, it ended with a rallying call to arms. According to the Reverend Earl of Musgrave, the endeavor to be manly was indeed, a 39 7. University of Minnesota Libraries, Kautz Family YMCA Archives. 40 Ibid.

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114 battle akin to the ways i quest for masculinity to the allegiance warriors pledged to Napoleon, despite the sacrifice to their life. It inspired fierce loyalty among men, dwelling in their shared experience of choos ing the to unify men in the struggle against peer pressure and social influence to remain pure. He concluded with ecumeni cal words of encouragement: So let us, notwithstanding the hardness of the way, and perhaps the wounds we shall receive in the endeavor to be true, let jus battle on, struggle on, trying to make grace and pow er we are able to go f orth conquering and to conquer. 41 must shed their current friends in the saloons, and suffer the loss of certain social capital, but the YMCA pro vided a new group identity through which men became manly This manliness viewed men as warriors against temptation, and united them on the battlefield of a vice ridden society. It encouraged them to envision themselves as conquerors, even as it pressed them to reject the convention of sexual conquest. Together, as a group, men could sustain a manliness that did not rest on the sexual pursuit of women, and this idea resonated with YMCA men. The Earl never int ended to publish this speech it s purpose was to address a live audience of men. This is significant because it meant that when men received his call to manly arms, they did not find themselves fighting the hard battle of manliness completely on their own. Instead, they could look around and glean o Other prominent YMCA events contained similar warnings about the importance of 41 Ibid.

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115 Associations of Massachusetts and Rhode Island, Rev. P hilip Moxom orated about the Christian community for American men. 42 h to personal purity was a holistic endeavor, not confined to Sunday service or gospels, but active in all parts of his life, and in all room, study classes, lectures, and social entertainments are all as important, in their 43 So many temptations assailed men daily, Moxom believed, that they required respite in the company of others who were similarly purity oriented. He emphasized the importance of acquainting on e self with those who engaged i n 44 free zone, gave men enough activities and intellectual stimulation to fill their time, and a group of other people with whom to share these pursuits. The archetype of male camaraderie lay in the relationship between Robert McBurney and Richard C. Morse. The two dedicated their lives to the YMCA and along the way they developed a rich, intimate friendship. Both men derived intense spiritual gratification from the male ma le love their friendship engendered. They even shared a residence for five years. 45 Neither married, but neither spoke of their friendship in terms of sexual partnership. Rather, their friendship, as John Donald Gustav Wrathall argues, is best understood within the context of romantic friendship. As Anthony Rotundo shows, some male bonds in the 19 th century were 42 Libraries, Kautz Family YMCA Archives. 43 Ibid. 44 Ibid. 45 Gustav Wrathall. Take the Young Stranger by the Hand, 49.

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116 46 Characterized by warm affection, shared interests, and abiding trust, male male bonds in the 19 t h century formed a strong social basis for 47 The personal work between the pair involved aspiring to spiritual and sexual purity, and to holding one another accountable for this. 48 Implicitly, then, homosexual activity was prohibited. But, t he YMCA did not explicitly address homosexuality as an issue until after the turn of the century, when medical conversations trended toward viewing homosexuality as a perversion and a disease. After 1900, YMCA publications instructed leaders to place prud ent context of marriage; and they devalued the bachelor secretary figure that had been so crucial to the models of male male love in the late 19 th century. 49 T he historiography on homosocial and homosexual life among men shows that in the early 20 th century, men used the YMCA and other urban establishments to find sex. George Gay New York illustrates a vibrant, mobile community of work ing class men seeking sex with other men existed as early as the 1870s. It remained largely unmonitored until anti vice activists raided some of the dancehalls and resorts in the Bowery 46 Class Youth in the Northeastern United States, 1802 see Carroll Smith Rosenberg, "The Female World of Love and Ritual: Relations between Women in Nineteenth Century Ame rica," Signs 1 no. 1 (Autumn 1975). 47 Perhaps men who associated marriage with imprisonment saw the marital tie as mutually exclusive to their intimate friendships with men. As companionate marriage emerged in the late 19 th century, the importance of roman tic friends for women and men declined. By the early 20 th century, such friendships would be viewed suspiciously. 48 class men. Gustav Wrathall, Take the Young Stranger by the Hand, 53. 49 John Donald Gustav Wrathall, Take the Young Stranger by the Hand, 45 69.

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117 where men gathered. 50 Yet it was not a secret: middle class white wome n and men knew about it, placed sex on display, and its emblematic figure was the fairy, a male who wore make up and feminine clothes. As Chauncey shows, sex bet ween men was not only common, but it enjoyed a celebrated visibility in the Bowery nightlife Clearly, the YMCA attempted to curtail this type of activity But it also responded to the broader, national urgency neurasthenia presented to the U.S. in the l ate 19 th century. Hundreds of men attended YMCA medical lectures in New York City which signaled they were thirsty for information about staving off nervous illness as best they could. The average attendance in 1884 for medical lectures was 900 attende es. 51 Another report from 1885 stated the lectures attracted an average of 1000 attendees. 52 In addition, testimonials reflected possible in this world. I also find I can perform more and better work with greater ease than I could otherwise. My occupation is of a sedentary character, therefore I have derived inestimable 53 The YMCA also provided a viable alternative to the men to theatres, saloons, to play billiards, pool, etc.; when I go ou t of a night now, I go to the 50 George Chauncey, Gay New York: Gender, Urban Culture, and the Making of the Gay Male World, 1890 1940 (New York: Basic Books, 1994): 34. 51 University of Minnesota Libraries, Kautz Family YMCA Archives. 52 Ibid. 53 Ibid., 11 12.

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118 54 place to go when I should otherwise have been idle, and thus does not give the devil a chance to 55 As these examples demonstrate, the YMCA had a lasting impact on the young men it helped. They strove to transform the character of young men by protecting them from overwork, especially in the types of professions that inspired nervous breakdowns and o ther ill health. They also supplied ample resources for filling the leisure time with virtuous activities. Overall, the YMCA shielded young men from exhaustion, idleness, and etter man in 56 The bureaucratization of the YMCA caused branches to open in cities across the United States. Urban reformers welcomed the proliferation of the YMCA because it promised to shar e the burden of urban immorality with churches. As cities swelled with immigrants and laborers, poverty, filth and crime mounted. Churches failed to keep up with growing indigence and vice in city life. While some religious leaders balked at the non deno minational approach of the YMCA, others found a helpful ally in the shared work of securing safe, Christian havens in a sordid modern world. 57 Though much of the history of the YMCA remains to be written, existing scholarship agrees that the YMCA performe d important cultural work to ease the intensity of urban life. It helped to blur the boundary between Protestant aesticism and capitalist profit making; it helped to recapitulate Christian self discipline in terms of broader social order 54 Ibid., 13. 55 Ibid. 56 Ibid., 14 15. 57 Nina Mjagkij and Margaret Spratt Men and Women Adrift: The YMCA and the YWCA in the City (New York: New York University Press, 1997): 34.

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119 in a modern world ; and most importantly for this dissertation, it introduced the physician as a reliable source of information on morality. In fact, by the end of the 19 th century, religious leaders endorsed scientific knowledge about sexuality as morally neutral and nece ssary for the pursuit of a chaste life. While scholars have recorded the cultural work the YMCA helped to do in assuaging the impact of modern life on young, especially in urban areas, it has not included the medical information they gave specifically to men only Medical talks simultaneously saddled them with worry about their sexual desires and behaviors and promised the knowledge and treatment of a physician could provide absolution. This chapter shows the YMCA was an important site for the transmissi on of manly ideas, and it did so through the lens of medical information. A manly man, by the end of the 19 th century, found moral purity through scientifically accurate sexual knowledge he gained from a trained physician. Scientific explanations for his sexual behaviors, such as masturbation, helped a man to understand himself better, to envision himself as normal, to respect women as more similar to himself than different, and to lose interest in the widespread prurience that threatened to sully his min d with misinformation and temptation. As a result, the YMCA functioned as an important source of information about sexuality for men in the late 19 th century. Primarily white, urban, and young, these men were likely candidates for lifelong bachelorhood, a lifestyle increasingly common for men of this demographic. 58 This lifestyle facilitated a manly ideal of vice: gambling, prostitution, drinking culture, and rejection of domestic life. For some, the unattached bachelor was a symbol of liberation from s ocial obligation to provide and reproduce, but for others, the fact that men rejected marriage and babies reflected a moral devolution. The YMCA, like its 58 Howard P. Chudacoff, The Age of the Bachelor: Creating an American Subculture (Princeton, N.J.: Princeton University Press, 1999).

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120 conservative Christian counterparts, sought to repair the crumbling edifice of society by sustaining a moral, chaste, and productive manly ideal. Dr. Ferguson believed self control and self denial would result in higher moral standing and better lives for all people. It is important to note that he did not mean denial or control of some sort of intrinsi c quality of manhood, but a learned one. He believed chastity was a choice, just like promiscuity. And it was linked to the pulse of the broader society. Without the ime would 59 C ontaminating the Minds and Health of Men The debilitating effect of urban America occupied the att ention of reformers across the country in the late 19 th century. As chapter one summarized, historians believe that neurasthenia performed an important role in addressing the cultural impact modern life had on the health and well being of young men in cit ies. YMCA organiz ers knew city lif e obscured familial connection and replaced it with isolated anonymity, which was precisely the reason community was so important. Hon. Chauncey M. Depew, president of the N.Y.C. & H.R. Railroad addressed this directly i 60 Two factors threatened 59 Archives. 60 University of Minnesota Libraries, Kautz Family YMCA Archives.

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121 t o contaminate the path to clean manliness at the end of the 19 th century: misinformation and bad influences. nerable years of puberty. 61 People possessed natural desire to learn about sex, he believed, which made the knowledge about xual life began fraught with a titillating sense of taboo. The way he described information about sex was as if it, too, was a contagion, and it could be put to either positive or negative uses. Ignorance, of course, left a place in the mind open to contamination. But he held greater concern for the impact of erotic literature he 62 Dr. Ferguson warned that close camaraderie among boys provided fertile ground for the spread of information about vice. One vice Dr. Ferguson found particularly ominous was masturbation. The cause of the masturbation epidemic came from poor instruction in youth and both boys and girls participated, though boys did it more. They typically learned the habit Then, they would introduce the habit to their friends at school, inducing a masturbation epidemic. As a result, the evil practice of self pollution. As a result, the discovery of masturbation was like a contagion, thrust into the curious minds into a population by one diseased child, and then quickly spread to 61 Archives. 62 Ibid.

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122 the other children. Thus, a male only space was productive insofar as it was chaste as soon as it became marked by salacious speech, it was a tainted community. This notion helps explain why for himself, but to his peers and friends. Should he fall to his temptations, he w would affect all the men around him. Reverend The Earl of Musgrave sympathized w ith this plight, acknowledging in talk end of the 19 th century. For some, he noticed, the athlete, the successful gambler, or the capable drinker represente d the manliest man. In one address, Dr. Ferguson bemoaned the messages literature calculated to produce alarm on this matter, could be made to experience the misery 63 64 Dr. Ferguson addressed the pressure many white urban men felt to demonstrate their manhood. Historian John F. Kasson argues many men negotiated their gender identity on their body and idolized manly strength in physical muscular form. For example, Englishman Eugen Sandow rose to fame in the U.S. 1893 for performing amazing feats of str ength. Sandow dazzled crowds across the U.S. by vaulting an enormous dumbbell over his head and forming a bridge with his body to bear the alternative to the broken, neurasthenic male body of the time. 65 When the YMCA presented its 63 Ibid., 14. 64 ta Libraries, Kautz Family YMCA Archives. 65 John F. Houdini Kasson, Tarzan, and the Perfect Man: The White Male Body and the Challenge of Modernity in America. (New York: Hill and Wang, 2001): 29.

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123 take on manhood, it did so amid a cacophony of competing models. The YMCA model of virtue and chastity must have seemed unattractive to many men, especially since alternatives offered plea sure, fame, and money. Peer groups undoubtedly urged men to engage in vice behavior, and YMCA leaders acknowledged how difficult it could be to resist. For example, Depew warned young men that le from others, and the social pressure uld reject his Christian pie ty and erty with his 66 Depew believed poor company sullied a thoughts that ultimately led him to prurience. These views echoed broader calls for social order and reform in the late 19 th century. It appeare d to reformers that ruinous manhood acted as a contagion. As such, it threatened an entire community of men, and as many believed the future of the nation. Dangerous Behavior and its Victims of the neurasthenia rhetoric: first, they declared boundary between healthy and dangerous sexual behavior existed on a delicately thin line. Lectures proclaimed that some aspects of sexuality were common and 66 University of Minnesota Libraries, Kautz Family YMCA Archives.

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124 healthy, but any man who crossed that boundary risked severe health consequences. Secondly, YMCA talks, like neurasthenia rhetoric, did not blame men. Instead, they believed that men succumbed to the enormous pressure of modern society, as victims of miseducation about sex and the malevolence of the ir surroundings. One inculpable figure in this narrative was the masturbating child. Unlike mid 19 th century moralists like Sylvester Graham and John Harvey Kellogg Late, late 19 th century medical models avoided moralizing sexuality but still cautioned against the obsessive potential for masturbation. 67 In his 1891 address on social purity, Dr. Ferguson spoke harshly about the masturbation. He remarked, This is a most dangerous habit, because it is a very common one. The great danger lies in the fact s that it can be practiced so often, that it fastens itself so firmly upon its victims, that it is so difficult of detection, and that, if continued, its results are so varied and disastrous. It would be difficult for the human imagination to think of a m ore abominable habit. 68 69 quarters. But he also intimated that some nurse s or female caregivers exposed boys to sex, either on deliberately or accidentally, and frequently introduce the concept of masturbation to unknowing children. Finally, the most pernicious influences came from residential colleges where people slept in cl ose quarters and the knowledge of masturbation quickly spread unbeknownst to authority figures. 70 Once again, the power of one bad influence destroyed the 67 Thomas W. Laqueur, Solitary Sex: A Cultural History of Masturbation. (New York: Zone Books, 2003): 48 66. 68 John Ferguson, Social Purity: A Lect Archives. 69 Ibid., P 8 9. 70 Ibid.

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125 sexual function of a child before he (or she!) was old enough to know what he was doing. Ferguson n sexual interest or pleasure. Instead, Dr. Ferguson leveraged his medical authority to stamp a masturbating boy with innocence and inculpability. From this persp ective, the masturbating child succumbed to the powerful forces of poor parenting and naughty peer influence obscured his own ability to discern healthy and moral choices for himself. The masturbating boy was, In a poorly educated, impure environment, Dr. Ferguson believed boys would inevitably fall to the temptation of sexual vice. Reverend Marcus Dods employed a similar perspective authored wit h a famous Irish physician Dr. John G. McKendrick. 71 This was one This speech epitomized the way the YMCA fused its evangelical Christian tr aditions with contemporary medical science. Like other similar pamphlets, the printed version casts a dark shadow over our 72 In this speech, Rev. Dods provided the religious morality to impart the dangers of sexuality; Dr. Ferguson provided the scientific rationale to support it. Together, they preached a medical morality to a crowd of young men. 71 This document is undated, but based on the affiliations accorded each speaker on the pamphlet cover, the talk was likely given between 1893 and 1906. 72

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126 excused the behavior as beyond the will of the individual man. Sexual ind iscretion, he wrote, afflicted possessed the fortitude to withstand sexual pleasure could be most dangerous. 73 He listed typical characteristics of neurasthenia: indigestion, irritability, fatigue and loss of urgency, e is no organ of the body which acts as it condition until a m an was already in grave danger. In the speech, Rev. Dods considered sexual indiscretion more broadly than Dr. Ferguson did including masturbation but also non marital sex with women. He taught that sexual activity bore emotional consequences, and when performed outside marriage, they could obliterate a 74 Dods resisted casting firm blame on young men for their sex 75 He portrayed society as a looming trap, waiting to ensnare unassuming dupes into a 73 Archives. 74 Ibid., 6. 75 Ibid., 5.

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127 web of masturbatory obsession. Despite his vast arsenal of religious and spiritual work, Dods framed this issue largely in medical terms. While Dods convinced men not to blame themselves for nervous illness, he also told Within the broader context of a c voices who portrayed nervous illness as a destructive foe with ever elusive origins and ambiguous symptoms This not knowing quality drove men into the offices of physicians for a definit ive diagnosis. Convinced they had robbed themselves of marital bliss, emotional fulfillment, and mental stability, men internalized the messages like these from Reverend Dods. They believed they had caused themselves irreparable harm, and sought medical care to alleviate not only their physical symptoms, but also the guilt a nd woe caused by the past. As c hapter six will show, physicians routinely encountered the feeling of woeful victimhood Dods describes in his talk at the YMCA. In the second segment enowned physician James G. McKendrick buttressed the message about v ictimized men put forth by Rev. Dods He established himself as a credible man of science by opening with a long explanation of basic animal and human repro duction. Then, he went on to discuss more illicit aspects of human sexuality. Using euphemistic terms, he warned that non marital sexual behavior not only argued that sexual indulgence turned men into captives of an unyielding master. He declared resh act connected with other forms of

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128 health; once damaged, alcohol, tobacco and gambling could trigger further sexual debility 76 rasthenic rhetoric: it presented men as victims of themselves of an insatiable nature that they could not always control, and for which they could not be held accountable. This perspective stands out because the official purity platform of the YMCA decri ed the presumption that men should have greater social or sexual license than women should sexual prowess altogether. In Medical Talks, however, the rhetoric of neurasthenia powerfully supe rseded the critique of the double standard. The image helpless, blameless captive of society and nature the white, young, urban American man motivated the efforts of the YMCA. Increasingly, the YMCA positioned itself bein g. For example, in 1895, Richard Morse, the general secretary of the International Committee, redefined the YMCA as not just a reform agency, but primarily engaged in remedial and preventative work --determined to prevent men from falling victim to a vice ridden society 77 That year, Morse delivered a state of the Association speech in Cincinnati, Ohio in which he described the successful efforts of the YMCA to alleviate homelessness, criminality, and destitution in young men. However, he pointed out, its primary focus was not rescue, but prevention. In the words of one of the most prominent leaders of the late 19 th 76 John G. M Archives. 77 Archives.

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129 78 The consistent image of men as victims cas t them as in need of help. Thus, the YMCA charged itself with preventing society from ruining its men. Neurasthenia as a National Emergency If society could ruin men, men also could ruin society. Medical lectures reiterated the urgency of the issue by ty ing prevailing weakness to a weakness in the nation Men learned their bouts of nervousness might conjure national peril Just as news and medical threate ars and anxieties about their own health and connected them to broader cultural panic about national security and American strength. A neurasthenic nation needed the inte rvention of the YMCA. The YMCA framed its objectives in national patriotic terms Because m aintaining healthy, vigorous men a microcosm of a healthy, vigorous nation -seemed increasingly diffi cult in the age of neurasthenia, YMCA medical lectures arti culated the pressure they felt to ensure this happened. In fact, as Dr. John Ferguson emphasized, the future of the nation depended in the well being of young men. In an 1891 Social Purity Lecture, he reinforced the work of the YMCA with broader importan for that power which is to save the nation 79 The YMCA community reinforced chastity in the individual, and therefore ensured the entire nation comprised healthy, stable, virtuous men. The YMCA work aime d to save men from impure influence s, but viewed itself as an antid ote to the contagion that spread vice throughout communities and into larger society. 78 P7. University of Minnesota Libraries, Kautz Family YMCA Archives. 79 Archives.

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130 Reverend Dods believed masturbation, though a solitary act, had broader effects. In his social purity seems to injure no one but the subject of it; yet it carries in its train sorrows, anxieties and pains which fill the life with wretchedness and which must implicate 80 retions afflicted his family. 81 As if that was not enough, Dods children as well. Informed by popular regeneration theory, Dods believed children inherited 82 In other words one victim begat a brood of victims, which eventually would turn into a nation of degenerates. mattered and could serve the nation well or bring its destruction. Dods words exemplify the prevailing late 19 th century anxiety that the health and well being of men and theref ore, the nation was vulnerable Thus, every individual comprised a key to the function of the larger social order. Depew argued a man who succumbed to hreatening all security for life and 83 The course of direction one man followed did not only affect him, but stood to tarnish those around him. 80 sota Libraries, Kautz Family YMCA Archives. 81 Ibid., P 6. 82 There may be something to be said here about the ways in which regeneration theory served as another reason to view men as victims and not wholly to blame. Dods does not go into it here. 83 University of Minnesota Libraries, Kautz Family YMCA Archives.

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131 In addition to private family consequences, the national economy also depended on keeping men out of the throngs of sexual vice. The Railroad Branch of the Association signaled to a clear example of the ways in which the healthy spiritual orientation of a single man reverberated to larger society: a healthy man worked harder, improved service, stimul ated profit increases for the railroad company that became wage increases for the average worker. Men invest their salaries in their families and homestead, creating happy and sober environments in which to raise children. Directly, railroad workers ensu re safe transportation for millions of travelers so all workers need to remain clear headed and focused, otherwise they could cause consequences and long term societal level effects. His example, the railroad, provides a template for how significant it was to secure the health of men. Between 1860 and 1880, the railroad industry tripled the miles of track in the United States. It formed the backbone of the economy and symb olized American prosperity and ingenuity. This industry lay in the hands of each of whom performed singular tasks that amounted to a sum greater than the parts. 84 Thus, the YMCA sought to sustain the health of a nation the safety of its railroad passengers, the smooth delivery of goods across the country, a nd the growth and expansion into new territories via rail. 85 Once again, the morality of one man could sustain or destroy the entire nation. 84 University of Minnesota Libraries, Kautz Family YMCA Archives. 85 The YMCA had a special division dedicated specifically to railroad workers.

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132 of good for their city, their 86 The stakes were high because one abuse or extra marital intercourse was not as solitary as one might think. It reverberated into his conscience, his body, his marriage, his community, and eventually, his nation. Healthy men required proper sexual education and an affirming community of other men. The next two sections explain how the YMCA responded to the problems of sexual vice and neurasthenia by promoting candid medical information as well as encouraging men to fortress themselves within intimate, chaste bonds with one another. The Role of the Physician Even as early as 1871, YMCA officers promoted the physician as a reliable figure who migh would alert a man to the dangers of masturbation and steer him back toward a healthful abstinence. 87 As the end of the century approached, published material about t he subject continued to assert the authority of the physician as the most trusted voice on the matter. The the medical information changed over time. First, physici ans could not only provide a medical emotional tax that sexual dysfunction wrought on them. Second, a growing suspicion that not all physicians aimed to cure men suggested a growing awareness that quacks and profit motivated 86 University of Minnesota Libraries, Kautz Family YMCA Archives. 87 Archives.

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133 expertise granted him significant credibility, it could not be unquestioned. Reverend Moxom spok e to an audience of young men about the role of the physician. He Moxom advocated organizations invited physicians to come once or twice a year to speak plai nly about moral hygiene and sexual purity. To some the recognized physician will speak with an authority that even the minister of religion may not have. The course which I suggest is the more needful because, in every city, there are medical quacks who se advertisements beguile the ignorant, and whose pseudo scientific pamphlets on the sexual functions are often as corrupt and corrupting as they are pretentious and false. 88 dical man would prevail over a small, convivial group of young men with effective moral authority. Reverend Moxom, a religious leader, handed over authority to educate young men to the scientifically indic ated medicine and religion worked together to achieve social purity Following the recognition of medical information as a valuable moral tool, education about sexual matters became more frank and less charged. In fact, men in the Association Hall gathere d to hear messages about how common masturbation could be, and how readily men fell susceptible to its temptations. As the previous section showed, the knowledge of masturbation acted like a contagion and could quickly tarnish the integrity an entire grou p of men. However, medical perspectives by the end of the 19 th century demonstrated a qualified perspective of that 88 y of Minnesota Libraries, Kautz Family YMCA Archives.

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134 information could actually protect him. Thus, the medical talks offered by the YMCA counteracted the specter of a poisoned thought by speaking openly and frankly about the subject. The ultimate message remained clear: chastity and purity of the individual man cemented a stable future for the nation to purity, and so he must refuse to engage in it regardless of the social costs or the strength of the temptation. Ass ociation described symptoms of the habitual masturbator: at first, shame and bashfulness, but other symptoms. By 1890, men got a different message in the Associati on hall from Dr. is not bad. This is a perfectly natural thing, and would have taken place though self abuse had 89 In his broad add ress, Dr. Ferguson offered relief to many men in the room who likely had experience with nighttime emissions and struggled to make sense of xual choices. As shown in Chapter 3(?), men regularly linked excessive sex with unhealthy nighttime emissions; the legacy of earlier medical knowledge weighed on the minds on young men, many of whom eventually sought the counsel of Drs. Beard or Mitchell or who purchased mail order remedies. 89 Archives. Not all doctors at the time would have agreed with this statement, as many made t heir fortune by linking the two, or at least effectively scared people away from masturbating to generate a public perception that there indeed, was a medical connection between the act of masturbating and seminal emissions.

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135 ened. He told the young men: do not worry over the occurrence of emissions from time to time. You have no cause to keep your mind in a state of anxiety condition for the adult male to lose a certain amount of seminal fluid; and there would be just as much sense in taking medication to stop the flow of saliva in the mouth as to take medication to stop the flow of s eminal fluid. 90 Though seminal flow occurred naturally, Ferguson warned that which men encouraged 91 boundaries were clear: seminal emissions occurred naturally, but the emission compelled by Even as he began to condemn the practice, Ferguson retained a neutral, even handed tone. He presented himself as reasonable and trustworthy even as he condemned what he believed was a common practi ce. He came right out and acknowledged its ubiquity, knowing his audience had a personally vested interest in learning how to cope with the worry that stemmed some one here has practice d the habit. After you have done what I have just indicated, and you still have some fear on your mind, then go and consult some physician of known integrity whom 92 Additi onally this example reinforced the belief that not all doctors warranted trust Ferguson cautioned against the increasing market of so called doctors who aimed their advertisements at vulnerable young men (as discussed in Chapter 2*). Medical knowledge could 90 Ibid., 14. 91 Ibid. 92 Ibid., 11.

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136 not be believed without qualification especially not that which could be found in the advertisement pages of newspapers and magazines; professional prestige mattered. Ferguson reminded men to be savvy about their choice of physician. Compared to the unblinking authority later, medical marketing required proper investigation t o separate the legitimate doctors from the profit hungry charlatans. 93 Dr. Ferguson stressed the importance of learning about sex from a trusted source a parent or teacher future reproductive channel 94 sound information and acti vities so they would not fall prey to salacious literature and the prurient ways of the saloons. This was evident in the proliferation of printed material the YMCA supplied and its organization of rooms that made reading and learning a core component of u nstructured down time, and the formal informational lectures. YMCA organizers steadfastly believed impure information corrupted young men and the solution lie in ensuring men had ready access to valuable, moral information. This included information abo ut sexual health. Despite the insistence on sexual purity, YMCA instructional material addressed topics about sexuality frankly. They believed open discussion of the reality of sexual life could effectively thwart the titillation of learning about sex th rough literature, peers, or first hand experience. 93 Chapter five argues these two groups had more in common than historians have recognized. 94 Archives.

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137 Dr. Ferguson urged his audience to consider sexual knowledge as a medical issue rather the medical one to both bolster those who employed a religious framework for their purity campaigns, but also to those who rejected the religious motives in favor of scientific ones. From the medical perspective, Ferguson discussed four prongs of the movement: immoral literatu re, the solitary vice, prostitution, and diseases. On immoral literature, Ferguson spoke of the damaging effects that exposure to prurient literature wrecked upon both sexes. He believed adults should shield young people from the the years of discretion literature and guidance by trusted parents and teachers. 95 The appropriate age for such instruction varied from child to child, and revealed itself naturally. Ferguson believed the appropriate time to instruct children about sex was when they started inquiring about it, usually around puberty. Parents and teachers must provide healthy information, which he believed would occupy the space where insidious sexual knowledge could root if left open. 96 In the early twentieth century, sex education became more central to public service. Historians often credit the scourge of syphilis among soldiers in World War I for sparking the social hygiene movement. Professionalized social workers, nurses, and educators worked to clean up the filthy habits of Americans in the early decades of the twentieth century. In the interwar period, public health emerged as a recognizable and legitimate field of work. 97 By 1940, public school physical educatio n and biology courses included sex education in their 95 Ibid., P 8. 96 Ibid., 9. 97 Elizabeth Fee. Disease and Discovery: A history of the Johns Hopkins School of Hygiene and Public Health, 1916 1939 (Baltimore: Johns Hopkins University Press, 1987).

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138 curricula. 98 The YMCA became very involved in the education of young people in the United States during the first half of the twentieth century. Little is written about the sex education offered by th e YMCA in the final three decades of the 19 th century. In Taking the Stranger by the Hand John Donald Gustav Wrathall argues he topic. 99 He notes they wrote about sex using 100 He argues the t or at least most embarrassing 101 In fact, he points to an editorial from 1912 in Association Men that declared the knowledge about o know 102 As a result, Gustav Whitehall paints late 19 th century YMCA leadership as echoing a broader social and religious trend to remain silent about sex. However, historians have found that people in 19 th century America hard ly kept quiet about matters regarding sex. As my research shows, newspapers, print media, medical advertisements, traveling medical shows, and physicians themsel ves discussed sexuality openly and regularly by the end of the century. They used the framewo rk of neurasthenia to discuss the breakdown of 98 Susan Kathleen Freeman. Sex Goes to School: Girls and Sex Education Before the 1960s (Urbana: Uni versity of Illinois Press, 2008). 99 John Donald Gustav Wrathall. Take the Young Stranger by the Hand: Same Sex Relations and the YMCA (Chicago: University of Chicago, 1998): 20. 100 Ibid., 20 21. 101 Ibid., 22. 102 Cited in John Donald Gustav Wrathall. Take th e Young Stranger by the Hand: Same Sex Relations and the YMCA (Chicago: University of Chicago, 1998): 23

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139 bodies such as that of respected YMCA secretary Robert McBurney and by the 1880s easily included the sexual dimensions of this national epidemic to lend legitimacy and a sense of distance from the subject matt er. Through the lens of neurasthenia, discussions about sexuality could be framed as modern, medical, and morally neutral. The YMCA, generally speaking, took interest in presenting itself as a modern institution and placing some distance between itself and its evangelical origins. This is reflected in its architecture and professional secretaries. I argue the YMCA also signaled its interest in secularization by promoting the authority of the physician on matters of physical and sexual health. My rese arch shows that sex education talks, especially when given as men only Medical Lectures, were surprisingly frank, medically focused and aimed to create a comfortable space for men to learn about sex. The surviving lectures in the YMCA archives paint a pi cture of YMCA sex education before 1900 as a direct reaction to the more lascivious, and perhaps medically inaccurate, information young men received from classmates, novels, and older men and women. Even as Gustav Wrathall argues that YMCA le aders skir ted the topic of sex. The central argument of his book, Taking the Stranger by the Hand contends that between 1885 and 1920, the YMCA increased its focus on physical health as part of a mind body spirit paradigm. His evidence shows much of the formal or ganization of sex education happened after the YMCA International Committee began to distribute pamphlets about sex education in 1899. Prior to that, he stated, the publications focused only on purity. 103 But after that, his work focuses on the 103 Cited in John Donald Gustav Wrathall. Take the Young Stranger by the Hand: Same Sex Relations and the YMCA (Chicago: University of Chicago, 1998): 37

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140 20 th centur y, relying in 1899 as a significant turning point. 104 Historians often point to the social hygiene movements and the influence of Freud after World War I as the first time formal sex education truly took off. 105 To lump together the Gilded Age and Progress ive era erases the significance of the 1880s and 1890s. Though source material about the twentieth century survived to a greater extent, the end of the 19 th century witnessed the YMCA harness medical authority to promote sexual purity and good health amon g young men. In fact, I argue the process began as early as 1871, and blossomed in the 1880s and 1890s when it took on the framework of neurasthenia in the 1880s and 1890s. The rhetoric of nervous debility positioned men as both victims and empowered age nts. They were victims because modern society overwhelmed them with stimulation, and specifically regarding sex, abundant misinformation. It empowered them, then, to reeducate themselves and affiliate themselves with better influences. As a result, the framework of neurasthenia the so -allowed men to take physical health seriously in the 1880s and 1890s, not only for themselves, but also for their nation. Furthermore, it provided a bridge between earlier Christian as cetism and the more secular direction the YMCA intended to move. The YMCA, as Gustav Wrathall notes, served as a primary interlocutor of medical knowledge between the medical profession and ordinary people during this time. Th e 104 At times, sources are cited out of chronological order, thereby collapsing three decades of ideas from YMCA publications into a single set of ideas. 105 omen speaking about anti masturbation even before the Civil War; A pril R. Haynes, Riotous Flesh: Women, Physiology, and the solitary vice in nineteenth century America. (Chicago: University of Chicago Press, 2015). See also Mary Odem, Delinquent Daughte rs: Protecting and Policing Adolescent Female Sexuality in the United States, 1885 1920. (Chapel Hill, NC: University of North Carolina Press, 1995); and Christina Simmons, Making Marriage Modern: Women's Sexuality from the Progressive Era to World War II (Oxford: Oxford University Press, 2009).

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141 final section will discus s some of the overlooked effort the YMCA made to emphasize accurate, detailed sexual education as part of its duty to create a healthful community of young, pure men.

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142 CHAPTER 5 NEURASTHE NIA Introduction In the fall of 1894, newspapers across the United States entertained readers with stories of Aaron Hershfield, a wealthy banker from Montana who hoped to win a divorce case by status to offer an official diagnosis to the court, the newspapers unofficially diagnosed him with neurasthenia. The Associated Press covered his attempt to annul his marriage, and the subsequent attempt he made a favorable outcome in a divorce trial. These stories permeated local newspapers across the country. They portrayed Hershfield as a vindictive villain who attempted to besmirch his wife to escape alimony obligations. While many marital scandals peppere d newspapers, this one was particularly well covered in the media because it involved a wealthy man who committed several acts of bribery to compel others to testify to false evidence. Through this case, the public imagined the consequences of neurastheni a. I furthermore, it not only explained but eventually absolved his erratic and criminal behavior and echoed larger anxieties about late nineteenth century masculi nity. Newspapers and magazines in the 1880s and 1890s were an important source of popular sexual and marital issues. Daily local newspapers as well as more sal acious publications like the National Police Gazette generated a wealth of information about the failing sexual health of American men. Men read these widely available sources and used them to assess their own sexual behaviors and bodily health. As chapt er three showed, men seeking treatment from physicians for sexual neurasthenia already knew quite a bit about their condition. In some ways,

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143 this proved helpful because patients and doctors shared a language with which to describe nervous symptoms. Howev er, doctors believed reading about sexual neurasthenia led to self misdiagnosis which amplified their anxiety and nervousness about their sexual health. 1 George Beard, the physician who led the campaign to educate doctors about the epidemic of sexual n eurasthenia, asked his patients about what they read about their condition prior to consulting medical care. Because neurasthenia blurred the boundary between physical and mental illness, Beard believed ideas and information about sexual neurasthenia dire ctly impacted the health of the patient. This chapter examines the information about sexual neurasthenia and related sexual health and nervous issues that men encountered during the 1880s and 1890s, the period in doctors most regularly diagnosed white men with sexual neurasthenia. Men in the late 19 th century were inundated with instructions about how their bodies should look and function, and a lot of this information came from advertisements, newspapers, traveling medicine shows, and periodicals. Histor ians have paid attention to the ways in which different forms of media shaped a hegemonic masculinity which it characterized as white, muscular, aggressive, strong willed, hard working, and sexually active but morally restrained. 2 1 Beard, George M. Sexual Neurasthenia (Nervous Exhaustion) Its Hygiene, Causes, Symptoms, and Treatment, With a Chapter on Diet for the Nervous (New York: Arno Press, 1884, 1972): 46. 2 Gail Bederman. Manline ss & Civilization: A Cultural History of Gender and Race in the United States, 1880 1917 Chicago: University of Chicago Press, 1995; Julian Carter, The Heart of Whiteness: Normal Sexuality and Race in America, 1880 1940 (Durham, NC: Duke University Press, 2007); Kristin L Hoganson, Fighting for American Manhood: How Gender Politics Provoked the Spanish American and Philippine American Wars (New Haven: Yale University Press, 1998); Jacobson, Matthew Frye. Barbarian Virtues: The United States Encounters Fore ign Peoples at Home and Abroad, 1876 1917 (New York: Hill and Wang, 2000); John F. Kasson, Houdini, Tarzan, and the Perfect Man: The White Male Body and the Challenge of Modernity in America (New York: Hill and Wang, 2001); E. Anthony Rotundo, American Man hood: Transformations in Masculinity from the Revolution to the Modern Era (New York: Basic Books, 1993).

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14 4 Many of the messages ab out how to embody ideal manhood came from the media, and as chapter three has shown, many late 19 th centry men did not meet this standard especially with regard to their sexual vitality. In fact, many men suffered crippling anxiety about it. The same sou rces that disseminated ideas about hegemonic masculinity also identified the source of anxiety about failing to attain it: advertisements, newspapers, and traveling medicine shows offered valuable information about causes, symptoms and cures. While the ex plicit reference of the diagnostic category of sexual neurasthenia was rare, discussion about it under other names was ubiquitous. Just like neurasthenia took on many names and served as cultural shorthand for diffuse physical and mental health problems, sexual neurasthenia entered into public discourse in spirit much colloquial shorthand for the long list of symptoms doctors called sexual neurasthenia. Historians ha provide valuable insight into the ways in which men used them as reference when they decided to see a doctor for their sexual health. From this perspective, there is much greater continuity of the scandal surrounding Aaron Hershfield collision of medical expertise and media marketing. This chapter will show how the explosion of popular presses at the late nineteenth century allowed for the messages about sexual neurasthenia to reach broad audiences, and this further bolstered the perception that neurasthenia affected nearly everyone. Newspapers and magazines delivered neurasthenia rhetoric to the hands of male readers and spoke to their anxieties; these same sources also provided the solutions: they promised readers a medical

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145 solution was close at hand. As a result, popular medical knowledge about neurasthenia linked through which men could e xpress them without bearing any responsibility. This chapter highlights the role of popular presses and media sources in promoting sexual neurasthenia and as a psychological and physiological health concern into public v iew. Neurasthenic Breakdown in the National News Failed marriages, murder, and insanity: local newspapers headlined these spectacles on the front pages of local newspapers in the late 19 th century. In Philadelphia, admission of prominent figures into Blo ckley hospital for insanity was notable news. Tragic suicides prompted coverage of the mental instability which preceded them. Marital strife came out in stories of domestic violence and murder. Famous divorce cases also received coverage in the news. These topics are often considered the fodder of more salacious publications like popular tabloid, The National Police Gazette, however, they peppered the everyday newspaper headlines as well. While the tabloid stories of the Police Gazette magnified the sexual and violent elements of scandalous stories, it is crucial to first see how these themes played out in regular newspapers. Together, these sources worked in concert to address the perilous consequences of in particular, reflected a pervasive anxiety that men were no longer interested in or capable of performing their duty as Good Provider. Neurasthenia rendered them unfit for the economic responsibility of being breadwinner of their family; sexual neurasth enia challenged the reproductive potential of a man. Overall, the forces that placed men in positions of power over women seemed to be deteriorating. Marriages failed and divorce rates being were address ed in the context of divorce cases such as that of Aaron Hershfield.

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146 Aaron Hershfield met Miss Dell Hogan in their hometown of Helena, MO. Hershfield was a wealthy banker who operated a bank with his brother, J.D. Hershfield also profited from various investments, included a deal in 1882 when he joined several other men from Helena to incorporate the Yellowstone National Park Transportation company. 3 Dell Hogan was a cord accounts for their courtship or romantic feelings toward one another, however Aaron had two The media first took notice of the marriage a year later when shocking news of scandal surrounding the conditions of this marriage surfaced in newspapers across the country. The earliest account, published in September 1894, came from the Associated Pr ess in an article 4 surprised the couple at their room at the Great Northern Hotel in Chicago while they were seeing marry her. 5 they advised him to go to North Dakota to seek annulment of the marriage right away. They 6 In response to these allegations, Dell Hershfield 3 Red Lodge picket. (Red Lodge, Mont.), 04 June 1892. 4 (Indianapolis [Ind.]), Sept. 5, 1 894. 5 Ibid. 6 The Salt Lake herald. (Salt Lake City [Utah), Sept. 5, 1894.

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147 7 This first wave of spicy news coverage of the Hershfield ma rriage privileged the amount of money, Aaron Hershfield penned a letter to each lawyer, requesting he deny his y a desperate, cunning side of Aaron Hershfield, who clearly felt no sympathy for the financial or emotional state of his estranged trusted. He wrote to Mr. Nol 8 To 9 In e. In these private letters, Aaron Hershfield sought to clear his own name, too. them to act in any 10 7 (Indianapolis [Ind.]), Sept. 5, 1894. 8 Aaron Hershfield, letter to C. B. Nolan, 12 Fe 1894, Cass County Divorce Records, North Dakota State University Library, North Dakota State University, (Fargo, ND). 9 University Library, North Dak ota State University, (Fargo, ND). 10 Aaron Hershfield, letter to C. B. Nolan, 12 Fe. 1894, Cass County Divorce Records, North Dakota State University Library, North Dakota State University, (Fargo, ND).

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148 11 an illicit a lose his divorce case, and perhaps his reputation. The stakes for Aaron Hershfield were high in this case trongly about it, too. He my so 12 This He attempted to resolve the problem respectably, and informed Mr. Nola n he offered her $60 per month (about $1600 today), a sum 13 His letter intended to dissolve the 14 took the case anyways. Nonetheless, Aaron Hershfield contended he suffered from mental ill health the symptoms associated with sexual neurasthenia which made him suscept ible to the seduction and coercion of his so called wife. Court records from May 1895 revealed the mental instability he suffered prior to and because of the intense pressure Dell Hogan placed on him to marry. Aaron believed he had been coerced into wha 11 1894, Cass County Divorce Records, North Dakota State University Library, North Dakota State University, (Fargo, ND). 12 Ibid. 13 Aaron Hershfield, letter to C. B. Nolan, 12 Fe. 1894, Cass County Divorce Records, North Dakota State University Library, North Dakota State University, (Fargo, ND). 14 Ibid.

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149 him if he did not comply. emotional and mental well Hershfield] great mental anguish and suffering, weakening his mental powers and causing him to become sick in body and m i nd, and unable to resist the fraud, force and influence brought to bear on him by the defendant and her co 15 These symptoms fall squarely within the most common symptoms of sexual neurasthenia: a traumatic event pa withstand the overtures of Dell Hogan, and in this weakened mental state, he was unable to adjudicate a proper course of action. Instead, he fell prey to a mischievous money grubber, and a year later, found himself deeply entren ched in a legal battle to prevent her from pilfering away his fortune. Witnesses attested to seeing Mrs. Hershfield promenade around town in lavish outfits that her s alary at New York Dry Goods could not afford. 16 His case fell in concert with many like it in the late 19 th century: wealthy man seduced or coerced into marriage by young seductress, and then shackled by the conditions of the marriage. I will discuss the ways in which the Police Gazette exaggerated some of the themes about women and marriage in a later section of this chapter, but even regular newspapers bemoaned the constraints of marriage. In early September, 15 Library, North Dakota State University, (Fargo, ND). 16 Goods Company, and he went on record to confirm she made Dakota State University Library, North Dakota State University, (Fargo, ND).

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150 1894, -orce surfaced in the news The Philadelphia Inquirer ran a poem that epitomized the perspective of readers who would have readily I will sing a jolly jingle On the joys of living single And the happy times that mingle With a solitary life; How the fun is fast and faster That bestowed on you a master In a domineering wife. You may travel round with Freddie Billie, Charlie, Jack and Teddie, And go home when you are ready Or perhaps not go at all. You may tip the festive flagon, Get a Coney Island jag on, To comfront [sic] you in the hall. If a little game of euchre, Should decrease your stock of lucre, There is no one to rebuke, or Set you shaking in your shoes. You may follow up the races, Play them straight or for the places, Drop a half a hundred cases But when you once have blundered, With a mate you are incumbered. Why your sporting days are numbered So I sing a jolly jingle, On the joys of living single, And the happy times that mingle With a solitary life. 17 17 A.J. G. in T The Philadelphia Inquirer, Sept. 8, 1894.

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151 This poem illustrated the thematic context within which the late 19 th c entury newspaper reader money, and liberty. Wives kept careful watch over husbands, like an insidious platoon sergeant to whom one was bound for life. The critique of marriage in the late 19 th century was not confined to the homosocial environments of pubs and saloons where bachelors congregated. Rather, it was a well being: economic and mental. In thi the neurasthenia discourse. In both cases, men resisted the expectations they adhere to social scripts as duty bound providers. As this poem illustrates, marriage and wives robbed men of standards which compelled him to wed, conjured images reminiscent of the neurasthenic: weak willed and unable to withstand the discipline of his wife; worn down by constant policing; defeated by the routine denial of whimsical card games and unscheduled free time with friends. The most compelling overlap this poem and the sexual neurasthenia rhetoric is the framing of men as hapless victims of circumstance. Afflict ed men could not assume blame because they merely performed according to social expectation. Instead, they must be pitied and helped and supported in their endeavor to shed the forces that oppressed them. This context nestled the early accounts of the Hershfield divorce case in a larger public conversation about how men suffered tragically under the economic and social pressures of late 19 th specter lurked beneath brother and sister in law. Aaron took the advice of his brother and left for North Dakota to ated she

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152 sought after much more than her cost of living. Fellow residents of Helena verified she stayed in the classiest, most expensive Hotel in Helena, and donned expensive clothing while riding a carriage about town. Money was a key component to this divorce case and this weighed heavily on Aaron, economically and mentally. At the time, the legal tradition of coverture required husbands to continue to bear financially responsibility for their wives after divorce. Hershfield understood this, and boar ded the train to Fargo in hopes the judge would grant an annulment. wealthy men in the late 19 th century, Hershfield chose Fargo because of its relatively liberal divorce laws. One traveling lecturer of the period, L. Edmund Stover, mocked the many 18 One ke y reason for this was that North Dakota law required only three months residency before a person could be eligible for divorce. Other states required up to six months residency. 19 Additionally, North Dakota courts granted divorces to non citizens, attract ing couples from all over the U.S. and abroad. 20 As a result, the Fargo economy thrived on the rising divorce rate of the late 19 th century. Major newspapers advertised the ease with which people could obtain divorce in Fargo. New hotels and privately ow ned boarding houses attracted divorce seekers from the East. Every 18 The Sun (Fargo, ND), 1 894 19 Whi le state laws determined varied grounds for divorce, adultery ranked the highest, accounting for over 16% of divorces between 1887 and 1906. Other common grounds for divorce included cruel treatment, desertion, having a felony conviction, excessive alcoho l consumption, and at least one year of neglect. See Sauer, Michelle M. "North Dakota." Cultural Sociology of Divorce: An Encyclopedia. Ed. Robert E. Emery. Vol. 3. (Thousand Oaks: SAGE Publications, Inc., 2013): 901 902. 20 Ibid.

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153 day at noon, the North Pacific Railroad unloaded unhappily married travelers who checked into hotels nearby this established residency. Some stayed and integrated into the city, but other s rented the room for the purpose of the residency requirement. These folks left the room vacant and returned home the same day. 21 In addition, the local court profited from these cases. Judge McConnell, who presided over the Hershfield case, heard di vorce cases between other proceedings. 22 While economic motives encouraged the city of Fargo to attract couples seeking divorce, Fargo residents sometimes responded negatively to the morally questionable people who came to their town. Residents of Fargo did not seem to appreciate the abuse of their liberal divorce laws. As a result, some high end hotels in the area denied residence to anyone who was not from the area. 23 At times, locals gathered outside the court to express their disapproval. In some c ases, as eventually occurred with a witness in the Hershfield case, a Fargo crowd ran people out of town. The ensuing trial in Fargo occupied not only the attention of affected locals, but of the national news. The Associated Press carried the story and it was reprinted in newspapers across the United States between September 1894 and April 1895. Despite the early portrait of Aaron as an innocent victim to the predatory nature of the Hogan family, new information surfaced over the course of 1894 that ren amed Aaron the culprit. Most importantly, the couple had a daughter together after they married. In a court deposition in July 1894, Dell alleged that while she was pregnant, her husband deserted her on January 11 1894 at the Helena Hotel. Following the birth of their child, D ell suffered post partum illness and incurred significant medical charges. She 21 Ibid. 22 New York Times, 1896. 23 Ibid.

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154 the hotel. She testified to the court that in all the seven years she knew Aaron Hershfield in Helena, he was a man of sufficient means to cover these expenses. Therefore, she believed it reasona ble to expect him to put for th e funds. The couple lived in the Helena Hotel together. They rented two adjacent rooms with closets and bathrooms at a cost of $200/month (equivalent to about $5450 a month, or $181 a night today). After Aaron left, Dell could not afford the lodging, and so she moved to a single room at $100 a month until the baby was born. She soli cited the services of a nurse after the baby was born, and once again boosted her rental to two rooms to accommodate the baby and nurse. Dell suffered a bad case of nervous prostration and required intensive medical care. These costs accumulated in Aaron 24 This deposition bolstered her claim that her husband deserted his responsibility to provide for her and her baby. In light of the pending divorce case, Dell needed to show that she was destitute and in need of financial assistance. She comp leted an application for Allowance for Counsel Fees to allow her to obtain legal counsel despite the fact she had no funds. 25 The court demanded Aaron pay his wife $300 so she could obtain legal counsel for the trial. 26 to the $300 fee. 27 to provide reasonable financial care for his wife. These details did not make news headlines and took place in a relatively quiet fashion. 24 Affidavit. 25 July, 1894, Cass County Divorce Records, North Dakota State University Library, North Dakota State University, (Fargo, ND). 25 University Library, North Dakota State University, (Fargo, ND). 26 Ibid. 27 ota State University Library, North Dakota State University, (Fargo, ND).

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155 Meanwhile, A First, Aaron denied ever entering the marriage willingly, and he argued no child resulted from the marriage. Furthermore, he launched a vicious campaign against her sexual propriety, a ccusing her of an illicit affair with a man named Max Stein while they were in Chicago for their tein readily described his meeting with Dell Hogan at the Palmer House on Monroe Street in Chicago in late September 1893 around the time the Hershfields wed. He arrived at the Palmer house and Dell immediately whisked him upstairs to her room an unusual occurrence given women typically did not have 28 This testimony resonated with the caricature Hershfield drew of his wife in letters to her lawyer s. In these accounts, Dell Hogan appeared a two headed hydra: seducing some men for fun, and entwining others a wealthy man, no less into a marriage for money. While the media spared readers the lurid details, the prevailing tone of news coverage of th e case portrayed Dell as a predatory woman. The true indignity of the divorce case and of would shock the public by November. Public opinion swung in favor of Dell Hershfield as new details about the trial emerged on the f inal day of testimony. The court had denied an annulment, citing that both parties 28 North Dakota State University, (Fargo, ND).

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156 decision would assign fault for divorce, and if blamed, Aaron would assume hefty alimony costs. Stein and found the man did not exist. They suspected the man who proclaimed to be Max Stein in earlier depositions was an imposter. Suddenly, a divo climax of the trial involved witnesses who had been paid to perjure against the defendant, and they gathered outside the court befo re trial on the final day of testimony. Curious spectators cramped into the courtroom to see the story unfold. They certainly got a show. One newspaper 29 The mental stability of Aaron Hershfie ld came under close scrutiny as testimony revealed he engaged in criminal behavior to circumvent his marital responsibilities. In the final stages of the trial, onlookers learned Aaron Hershfield committed bribery and perjury and they wondered whether he was insane. First, they heard testimony from the Pinkerton Detective Agency in Chicago. Detectives traced the steps allegedly taken by Stein and Dell Hogan during their affair; they found no evidence that Max Stein even existed. New evidence, including letters and telegrams, revealed Hershfield had bribed the person claiming to be Max Stein, along with others who had corroborated the affair. The court learned of a man named Jake Holzberg who allegedly assembled a coterie of witnesses who accepted paymen t to provide false testimony to dishonor Mrs. Dell Hershfield. One of these men, Joseph Bee, claimed to have been hired by Jake Holzberg to travel to Fargo and testify on behalf of Aaron Hershfield. Holzberg instructed Bee to take the stand and tell the court he had seen Mrs. 29 San Francisco Call, Nov 2 7, 1894.

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157 Hershfield engage with a strange man in public before she had married Aaron. He was to claim credibility and present her has a harlot, unwor thy of alimony. The court viewed letters and telegrams from Holzberg to Bee, most of which included money. The correspondence also included specific details necessary for the testimony: the dates the then Miss Hogan supposedly h this man were August 10 15 when the couple visited Chicago together to get married; the letters also included information about what Miss Hogan was forget to bu 30 But Bee kept the letters, and indicated there were several others who had been similarly instructed to give the same testimony. Outside the courtroom, an angry mob became involved in the trial. In a fit of rage, local protesters atte retribution. Rather than go through with the testimony, Harry Freeman turned the incri minating began to crumble. Finally, the defense was able to prove perjury by proving Stein was not even in Chicago when he supposedly had the affair; evidence also s uggested Max Stein was a fictitious identity, crafted for the purposes of this trial. Additionally, the court learned that while she was in Chicago to wed Aaron. 31 Hershfield 30 Library, North Dakota State University, (Fargo, ND). 31 San Francisco Call, Nov 27, 1894

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158 pretended to be a lawyer when he interacted with Billings, but to no avail. Eventually, Hershfield admitted his identity and that he wanted help nullifying his marriage. Though Billings refused, Hershf ield was persistent, and even came to visit in person to persuade him to participate in this plan. Additional evidence further swung the pendulum of public opinion against Aaron Hershfield. Superintendent Devereaux claimed to have overheard Anderson, a witness who had 32 Aaron Hershfield denied sending telegrams communicating with Anderson about falsifying testimony. In addition, Mrs. diamonds which Hershfield allegedly bought for his wife. He did admit to paying the bill for attorneys trying to bully them. The defense attempted to eliminate from the record all the character. The court overruled the attempt, however Hershfield appeared criminal in the ey es of the public. To combat the mounting evidence against him, Hershfield claimed insanity. walked about town. 33 avor with the public 34 that has polluted the courts by Montana people 32 Affidavit. 25 July, 1894, Cass County Divorc e Records, North Dakota State University Library, North Dakota State University, (Fargo, ND). 33 The Philipsburg Mail Nov 29, 1894. 34 Ibid.

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159 the sympathy from the public for his so mindedness on the 35 They public no longer sympathized with him, and they considered his deception to be a moral aff ront to honest women and men everywhere. public was faced with the q uestion of whether his illegal behavior was excusable because of mental illness. Increasingly, insanity was a viable scapegoat for criminal behavior in the late 19 th century, and physicians were solicited for expert testimony on the mental stability of th e defendant. 36 whether that was truly the case. 37 The final witness was Dr. Alexander Moore, who spoke 38 The defense hoped to convince the court Hershfield was temporarily insane and could not be held financially accountable for alimony for his soon to be ex wife. arriage of November 27 th 1893, was in all respects valid and binding contract of marriage, and the same was and is free from Furthermore he decided 35 Ibid. 36 See Charles Rosenberg, The trial of the assassin Guiteau: psychiatry and law in the Gilded Age (Chicago: University of Chicago, 1968). 37 The Anaconda standard. (Anaconda, Mont.), Dec. 2, 1894. 38 Herald Democrat, November 27, 1894.

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160 39 The final de cree of the court viewed the Hershfield marriage as legitimate. prior to said marriage, have sexual intercourse with any other person than the plaintiff in this action, nor did she prior to such marriage conduct herself in a lewd, lascivious, or improper accusations of coercion were without merit. 40 It appeared the def ense successfully convinced the court that Hershfield married, fabricated an affair, and conducted bribery with a sound mind; thus, the court found him liable for his role in the dissolution of marriage. Judge McConnell charged him to pay $35,000 to his w ife. 41 In addition, Hershfield would be required to compensate his wife for $1900 in legal fees. 42 Mrs. Hershfield declined to settle for less, and Aaron and his brother J.D. Hershfield 43 Newspaper head lines about the decision vilified Aaron Hershfield. One headline 44 The Philipsburg Mail The San 39 4. Cass County Divorce Records, North Dakota State University Library, North Dakota State University, (Fargo, ND). 40 Dakota State University, (Fargo, ND). 41 "Condensed Dispatches," The Washington Post, Dec 4, 1894. 42 Bismarck weekly tribune. (Bismarck, Dakota [N.D.]), April 26, 1895. 43 The Philipsburg mail, (Philipsburg, Mont.), Dec. 6, 1894. 44 San Francisco Call, Nov 27, 1894.

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161 Francisco C all 45 46 Newspapers leveraged judgments about the outcome of the trial and easily depicted Aaron Hershfield as a morally unkempt individual. Void a confirmation of insanity, the m ental health diagnosis was left up to the media -and they deemed him to be a neurasthenic. The Anaconda Standard characterized neurasthenia d. Like many articles about nervousness, this one provided detailed background information about the disease, including its ambiguous designation as a definable disease. The article presented a lay version of the case history. It introduced Hershfield, w ho had been struck by this so to suffered a blow to the head with an umbrella by a family member, which damaged his spinal cord. The ne wspaper determined Aaron also had cranial neurasthenia, believed to be housed in information about neurasthenia found its way to the public through the lens of neurasthenia. 47 The explanation that neurasthenia, a commo n, treatable disease rather than insanity, which was a life sentence much less damning light. Whether he actually attempted to desert his wife and infant daughter is less important than the way the events unfolded in the media. Once placed within a discourse of 45 Ibid. 46 Herald Democrat, November 27, 1894. 47 The Anaconda standard. (Anaconda, Mont.), Dec. 2 1894.

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162 willed nature and susceptibility to a sexually robust women paralleled stories of many other men at the time. News media and other forms of popular medical information teemed with rhetoric about helpless, run down men. Their physical and mental frailty made their sexual relationships particular particularly vulnerable to attack by the archetypal conniving woman One of the key features of the discourse of sexual neurasthenia is that it did not blame the victim. As subsequent analysis of the advertisements, medicine shows, and tabloid news will bility from a man himself. Instead, they characterized sufferers as victims of circumstance, and not to be condemned for the manifestation of their disease. This may explain why media criticism of Aaron Hershfield disappears after the trial ends, even th ough he refused to pay his ex wife the court mandated amount. In fact, on March 14, 1895, Mrs. Hershfield filed a motion against her husband for failing to pay the $1923.40 she had been awarded by the Fargo court. Aaron evaded the fine, and Mrs. Hershfie ld responded by suing him in a court in their hometown of Helena. On attorney secured a ten day stay of execution following this ruling. 48 There is no evidence he ever coverture. Not only that, but he was no longer married. wedding mad 48 Bismarck weekly tribune. (Bismarck, Dakota [N.D.]), April 26, 1895.

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163 iously an attractive woman with brown hair and medium build. She was in her mid thirties and hailed prior one: the St Paul Daily Globe 49 The sister in law, who disapproved of the marriage and roused trouble for the couple. This article neglects to mention the annulment proceedings, his mental health, or his criminal acts. Instead, the stor y was reduced to basic facts: Hershfield sought divorce and the court granted it. 50 The Hershfield divorce story provides a strong example of the flexibility of the sexual from blame. Legally, he had to repent for his misgivings and pay his ex wife a small fortune. But socially, he was absolved from his wrong doings. The cultural context of neurasthenia cushioned his reputation. Subsequent reporting on Aaron Hershfield focused on his financial investments. 51 In 1901, he came under scr utiny in a federal trial for forging signatures of two nonexistent bank employees. 52 The case was dismissed due to insufficient evidence, and he 49 St. Paul daily globe, (Saint Paul, Minn.), 17 Feb. 17, 1896. 50 Ibid. 51 The Philipsburg mail, (Philipsburg, Mont.), March 19, 1896. 52 The Kalispell bee, (Kalispell, Mont.), Jan. 12, 1901.

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164 faced no subsequent trial. 53 Despite the high were not eve n mentioned. His character, as a recovered neurasthenic who had repented and actions could be explained as a symptom of illness. It provided no permanent mar health or reputation; in fact, it could be used to obfuscate responsibility for his own actions. These themes of the temporary nature of disease and denial of culpability featured e trials of marriage, and sexual diseases. The next sections provide further historical context to show that the assumptions made being were not unique to the Hershfiel commonly identified in name, as in the Hershfield case. However, the sexual nature of these neurasthenic accounts including Aaron Hershfield was so strongly implied that readers could rasthenia were clear to patients was tied to mental health, duty as a husband and father, the role of the provider, and sexual performance. One place where the sexual nature of these conversations was notoriously explicit was in The National Police Gazette. 53 The Billings gazette, (Billings, Mont.), Jan. 18, 1901.

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165 Sex and Scandal in The National Police Gazette Sexuality and m asculinity dominated the pages of The National Police Gazette, one of between appropriate expressions of masculinity and sexuality are well documented by histo rians. Within the context of several broader social forces namely scientific evidence attesting to the immutable distinction between the sexes, the growing anxiety over the instability of social power for WASP men, and the shifting sexual mores allowing fo r delayed marriage and lifelong bachelorhood Police Gazette. According to extensive analysis of the magazine by Guy Reel the Police Gazette h e believed to be emblematic of the period. 54 and weird wh 55 Ultimately, the magazine circumscribed a boundary of healthy manhood and educated men on the causes and consequences of transgressing this boundary. The National Police Gazette published in New York City, circulated wid ely among men for over fifty years. First published in 1846, it initially covered police endeavors and crime, but by 1879, a new owner, Richard K. Fox, had changed the tenor of the publication. One scholar 54 Guy Reel, The National Police Gazette and the Making of the Modern Man, 18 79 1906 (New York: Palgrave Macmillan, 2006): 9. 55 Ibid. 15.

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166 nineteenth and early twentieth century America. 56 Remembered by historians as a tabloid, the Police Gazette nineteenth century. It could be found lying ar ound eating houses, saloons, and pool halls, where a growing subculture of young bachelors congregated. Historian Howard P. Chudacoff described these marriage but man aged to create social stability and accountability among one another. 57 In these places, particularly saloons which served alcohol (and sometimes, the best lunches in town were offered for free!), men read copies of the Police Gazette. Its popularity and influence was so 58 He characterized it as a blend of Playboy, The National Enquirer, and Sports Illustrated. Subscriptions to the weekly publication topped 150,000 durin g the 1880s and 1890s; some special issues boasted 400,000 printings. Over half a million men read it weekly. 59 T he popularity of the magazine caused it to join ranks with other notable publications of the period such as dies Book. 60 This made it a prominent force in 61 It contained impressive wood cut illustrations of sexual situations or violence. It featured images of 56 Guy Reel, "Dudes, "Unnatural Crimes," and a "Curious Couple." Journalism History 41, no. 2 (Summer2015 2015): 85. 57 Chudacoff, Age of the Bachelor 103. 58 Ibid. 186. 59 Chudacoff, Age of the Bachelor, 187. 60 Each of these publications could charge one dollar per advertising line in a column. See Chudacoff, 191. 61 By 1879, Irish immigrant Richard K. Fox took over as publisher of the magazine and launched it into wide circulation and fame. He successfully promoted 16 pages of sports, scandal, sex, and sin.

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167 prizefighters giving these athletes more visibility than those from other sports --and showed off their muscular body to the audience of bachelor readers. In 1880, it added a new section called which included wood cut images of women showing bare ankles, feet, arms, and cleavage. Scholars have written sufficiently about the ways in which these images worked together with the text to reify sex differences and racial hierarchy, and to rouse suspi cion of white women and non white men. Stories of enraged wives murdering their husbands, mistresses in fits of jealousy, or coverage of violent crimes committed by young black men supported this suspicion. The theme of feminine weakness underlay many of the stories 62 found in burlesque, where working class women used their sexuality to manipulate middle class men. The Gazette presented these themes to both assuage anxiety about class tension as well as titillate readers who may have found such role reversals erotic. 63 The magazine successfully captured the attention of male readership which struggled to understand changes brought on by modern life. Some questioned the purpose of marriage; others pondered racial difference; and still others fanned over the increasingly popular muscular male body. The Gazette focused spe cifically on these themes, and reflected a profound interest and concern about them among men. The muscular male body featured prominently on the pages of the magazine, presenting a picturesque image of the apex of the healthy male body. The pu blisher, Richard K. Fox sponsored boxing matches using belts and cash prizes to reward winners. These Gazette 62 Police Gazette shows the magazine portrayed women as victims of violence in a majority of the cases of violence. 63 Chudacoff, Age of the Bachelor, 205 207

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168 supported events served a reciprocal purpose of generating buzz around the newspaper. This was a time when spectator sports were rising as part of leisure culture. Fox supported less common sports as well. He awarded belts to people in a number of competitive activities, such as dancing, bridge jumping, and steeple climbing. 64 Sexual scandal figured prominently in the headlines of the Police G azette but it mostly focused on marriages gone awry or forbidden trysts in which one partner was previously engaged. These representations of the amorous and sexual encounters between women and men are well documented by historians. 65 James Joyce famousl Gazette 66 One historian, Mark Gabor, viewed the Gazette as the first ankles, equipped with exaggerated brea sts and buttocks. 67 saloons and pool halls. 68 Not all women were portrayed as passive objects, however. Many portrayals of women blurred the conventional virgin vamp dichotomy and flirted with the boundaries of feminist zeal: some danced, some exuded coquettishness, and some were athletic. Though many were shown in distress, as victims of violence, they also represented the potent ial to seduce or disempower men through their wiles. Fox wrote about women in a cautionary 64 Reel, The National Police Gazette and the Making of the Modern Man, 58. 65 The National Police Gazette and Gilded Media Studies Journal 6 (Winter 1992): 1 15 and Guy Reel, The National Police G azette and the Making of the Modern American man. 66 James Joyce, Ulysses, (Oxford: Oxford University Press, 1998): 310. 67 For more on girlie magazines, see Mark Gabor, The Illustrated History of Girlie magazines: from National Police Gazette to Present. New York: W.W. Norton Co., 1992. 68 Reel, The National Police Gazette and the Making of the Modern Man, 155.

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169 manner. He published against women drinking too much, for example. Fox believed the Gazette reported on the truth, and while it gained popularity because these st ories were salacious, they ultimately served a greater good by telling the cautionary tales of women who acted badly. 69 These themes resonated with those found in more traditional newspapers, such as the poem about bachelorhood in The Philadelphia Inquirer described earlier. Men encountered resounding messages that their financial independence and sexual liberty were under attack. At the same time as the Gazette brandished sexual scandal and inspired distrust in women, it also besieged its readers with a dvertisements about weak men, lost virility, and sexual health concerns. My analysis of the rhetoric used in advertisements, images, and news stories ithstand the changing social lands cape of modern American life. These ads provided a major source of popular health information which a half million men took in each week. Some of that rhetoric would eventually about virility and sought out medical care to remedy them. The Police Gazette incorporated language about nervous illness into its lexicon more in the 1880s and 1890s than in other decades. In the 1870s, just four entries spoke of number jumped to 63 in the 1880s and 35 in the 1890s. Writers also twentieth century. In the 1880s, 258 items mentioned nerves; in the 1890s it was 125, and between 1900 and 1906, Gazette mentioned nerves 484 times. Terms about manliness 69 Reel, The National Police Gazette and the Making of the Modern Man, 164 167.

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170 70 appear more frequently in the 1880s than any other decade. 71 The term neurasthenia did not appear in the Police Gazette until June 4, 1904. Listed omes Caused by and urged them to seek treatment for their potentially ruined manhood. Dr. C. S. Ferris promised for free! While neurasthenia was not mentioned in the other ads, the connection between nervous debility and sexual performance was clear: Perry Products Co. pitched their sell their Nerve Restor er to help remedy the problem. The message from this single page in this the readership of the Police Gazette 70 "The Manly Art." The National Police Gazette 38, no. 193 (Jun 04 and dog tussle in which chunks of flesh were chewed o ut of one another 71 This is interesting because historians tend to think manhood and masculinity are different things. Anthony Rotundo wrote that the shift from manhood in the 19 th century to masculinity in the 20 th century mark ed a move toward modernity. Bederman argued in Manliness and Civilization that manhood and masculinity were distinct: class Victorian cultural formulation which grew shaky in the late nineteenth cent ury. Thereafter, when men wished to invoke a different sort of male power, they would

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171 A theme of injustice permeated these advertiseme nts, that the ill health and sexual impotence of men across the country were somehow not their fault. One ad for Vito Chips in 72 This language of entitlement straddles both sides of the debate over whether sex differences were physiologically irrefutable or socially conferred. The rhetoric of nervous debility suggested that body was broken down, lessening his physical capacity to take charge and participate neurasthenia was commonly considered a disease procured by behavioral factors as much, if not own doing. These ads provide a narrative through which culpability for emissions, loss of desire, and impotence could be exchanged for one ab out restoration and redressing an unfairness. The blame shifted away from men themselves, and toward a third party, making not only the discomfort and disease more palatable but the process of reaching a solution seem more reasonable and appropriate. Adv ertisers took care to acknowledge the sensitive nature of the subject matter at hand. Because these products were mail ordered, a potential customer had to send a letter with his name and address on it, requesting information or treatment. By writing in, he risked exposure for having some sort of sexual health problem. To counter this, advertisements often included an Turkish ointment. Pabst Chemical Co. assured customers their gonorrhea treatment would arrive 72 Advertisement 8 -no title. (1905, Feb 04). The National Police Gazette (1845 1906), 86 15.

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172 most comforting app n this page due to its detail. He was well dressed and professional. He appeared to be looking at the reader, but the imposition of his gaze was disarmed by the coquettish sideways turn of his head. The image contrasted the one right below it, a portrai t of an authoritative mustached man staring into the distance. Dr. Fred appeared friendly and trustworthy someone whom readers may be inclined to trust with their deepest sexual worries. Overall, these advertisements portrayed a representative example of the ways the historian that sexual virility was associated with feelings of shame, embarrassment, or impropriety, which may explain why advertisements went out of their way to make a case for confidentiality. At one dollar per line, advertising space in the Gazette was not cheap, so the inclusion of privacy meant that men felt their sexual health concerns were private matters --that even learning about sexual h ealth would require discretion and confidence. The high cost of advertising space, coupled with the consistent appearance of these remedies for sexual neurasthenia, show the ads worked. This does not mean the remedies worked; in fact, the medical value of the proscriptions is of little consequence. The fact that it continued to be lucrative to place ads in the Gazette shows that men continued to buy them. Anxiety over sexual health featured prominently in the lives of late 19 th century men. Quackery

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173 Police Gazette roused suspicion and consternation among physicians. They readily dismissed these remedies as eeking to make a quick profit. Doctors of the period worked tirelessly to maintain an oppositional and clearly defined distinction between describing them un ilaterally as not real medicine. 73 However, I argue that sexual neurasthenia provided a rallying point which united so called quacks with professional doctors sanctioned by deserves to be taken as seriously as that of their more institutionally reputable counterparts. Because print media blended information about the two without reliable discernment, men received information about sexuality in the same way. This argument bu 74 She showed that one of the most important sites of contestation over who would speak as medical 75 Critics of these medical institutes viewed the fact they needed to advertise as evidence of their illegitimacy; furthermore, their affiliation with sex 73 See Jam es Harvey Young, The Toadstool Millionaires: A Social History of Patent Medicines in America before Federal Regulation. (Princeton, NJ: Princeton University Press, 1961). See also popular histories such as: David Armstrong and Elizabeth Metzger Armstron g, The Great American Medicine Show: Being an Illustrated History of Hucksters, Healers, Health Evangelists, and Heroes from Plymouth Rock to the Present New York: Prentice Hall, 1991. Bob McCoy, Quack! Tales of Medical Fraud from the Museum of Questionab le Medical Devices Santa Monica, CA: Santa Monica Press, 2000. 74 Fischer, Suzanne Michelle, Diseases of Men: Sexual Health and Medical Expertise in Advertising Medical Institutes, 1900 -1930 Order No. 3371848 University of Minnesota, 2009 Ann Arbor Pr oQuest. 20 Feb. 2016 75 Ibid., 7.

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174 James Harvey Young, who wrote the first history of quack medicines in the 1961, surveyed resupposed a single, definition of quackery with which all readers would agree. 76 The book had a mocking tone and neglected to consider any potentially helpful uses for the remedies he studied. In her dissertation on medical institutes, however, Fisher argues that traveling medical shows and institutes, though fraught with unethical profiteers, did bring medical information to the public. They reached people who otherwise may not have had access to important information about sexual health or venereal d isease. 77 Overall, because patient records are not available. Much of what is known about them comes from the more infamous clinics, the Heidelberg Institute in St. Paul, Minnesota. 78 She argued that one factor which explained the popularity of these clinics was their willingness to treat diseases no one would. I prominent physicians in New York and Philadelphia were, in fact, readily treating these diseases. In this way, these camps were not as separate as historians have thought. I argue sexual neurasthenia engendered a collaborative effort between so called quack medicine, and the professionals sanctioned by the AMA. Furthermore, both parties inherited the nature based discourse of cures for neurasthenia: So called quacks promoted plant based remedies, and professional doctors encouraged healthy diet and restful time in nature. 76 This is part of the subtitle of his first book, Toadstool Millionaires. See also James Harvey Young, The Medical Messiahs: A Social History of Health Quacke ry in Twentieth Century America (Princeton: Princeton Unive rsity Press, 1966). 77 Fischer, Diseases of Men 18 20. 78 Interesting side note: Aaron Hershfield met his second wife while receiving medical treatment in St. Paul. I have not found evidence that he was treated at one of these institutes, but one must wo nder.

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175 The American tradition of patent medicines began in Great Britain in the 17 th century. ry and diarrhea. 79 Most soldiers self medicated for these problems. After the war, medical advertisements used war the back of a fake Confederate currency. 80 M edical professionals routinely lamented the breadth of available medicines which merely stimulated or numbed the patient through artificial intoxicants. To combat this, patent medicine advertisements emphasized the natural ness of their products. The lat e nineteenth century witnessed an explosion of patent medicines. In fact, historian Stewart H. Holbrook deemed the post medicines. 81 So called quack medicines were available at local pharmacies and were prod uced widely. They were also made of organic ingredients, and this fact was promoted. The culture of natural remedies for neurasthenia rest, wholesome food, fresh air echoed in the presentation of quack 82 Two companies in 1890s. These companies boasted the purification qualities of their product, capitalizing on the natural healing properties o Journal of American Medicine questioned the potency of the treatment. In a published report, they found 79 Charles Goodrum and Helen Dalrymple. Advertising in America: The First 200 Years (New York: Harry N. Abrams Inc., 1900): 24. 80 James Harvey Young, The Toadstool Millionaires: A Social History of Patent Medicines in America before Federal Regulati on. (Princeton, NJ: Princeton University Press, 1961). 81 Stewart H. Holbrook, The Golden Age of Quackery (New York: The Macmillan Company, 1959): 46. 82 Ibid.

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176 sarsaparillas contained the advertised root, but it was so diluted by sugar, iron, alcohol and other additives that they could not reasonably attest to its medicinal effectiveness. The Journal concluded laymen imbued false faith in the treatment, and could potentially cause harm. 83 Another popular item was celery, believed to cure nervous diseases made from celery, hops, and coca. Advertisements emphasized the exotic coca component, leaning on examples of South Americans who chewed the leaves of the coca plant and immediately gained vitality. Wells & Richardson Company in Burlington, Vermont produced a celery Things in the line of Aids to Health and Happiness. By the 1890s, the market exploded with replicas: Celery Bitters, Celery Vesce, Celery Crackers, Celerena, and Celery Cola. 84 One of 85 Newspaper accounts testified to its ability 86 combined plants and roots to serve up a nutritious cure all for afflicted women. The nurturin g figure who passed down family remedies. Late 19 th century quack medicines, as an aggregate, promoted medicinal remedies made from healthy foods. They provide evid ence that Gilded Age 83 Ibid., 47 9. 84 Ibid., 53. 85 For more on this, see Sarah Stage, Female Complaints: Lydia Pi New York: W. W. Norton and Co.: 1981; and JANE MARCELLUS, "Nervous Women and Noble Savages: The Century US Patent Medicine Advertising." The Journal of Popular Culture 41.5 (20 08): 784 808. 86 GAINS STRENGTH AND WEIGHT." The Washington Post (1923 1954), Oct 02, 1928.

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177 Americans, despite all the trappings of modern society, clung to the belief that the best way to maintain health was by natural means. recou nts one notable example of Dr. William M. Raphael of Cincinnati, Ohio who boasted he had drunk of the infamous Fountain of Youth in Florida. In 1858, he offered to share what he d patrons. His Fountain. He charged a steep price of three dollars for his treatment. To justify such high cost, he claimed international success stories. A n Arabic sheik named Ben Hadad was one example, and Dr. Raphael described the man as not only still alive at 109 years, but still able to sire children. Hadad reportedly fathered 77 children by several wives. 87 By appealing to the virility of the sheik, r egardless of age, this ad generates a sense that an active sexual life not only could iage and children signaled a man was healthy. animal powers to healthy action, and with vigor comes natural desire It brings the system up to the virile point and keeps it there 88 Raphael developed another line of treatment in a similar vein: The Galvanic Love Powders which swore to reliably maintain sexual vitality. 87 Ibid., 69 70. 88 Ibid., 70, italics original.

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178 Advertisements for the Love Powders stated ethics prevented the doctor from providing direct te stimonial to their success; he must maintain the privacy of his patients. 89 One mail Orchis summoned a Greek reference to sexual aggressiveness. The Orchis Extract label was a photog raph of the Chicago Union Stockyards, suggesting the meat packing industry housed there harnessed its sexual force from the genitals of cows and sheep. 90 Packers Product Company e from the testicles 91 Manhood and Secret Diseases of Men campaign to rouse medicines remains homeopathic remedies today what is most compelling for the study of neurasthenia is that an entire economy capitalized on the anxiety of men, exacerbated their fears, and sold them 92 While he d ismissed them as viable medical treatments, I argue they provide a ripe rhetoric about masculinity. Most importantly, they show sexuality to be at the the ads successfully separated men from their money. In other words, they worked. 89 Ibid., 71. 90 Ibid., 72. 91 Ibid. 92 Ibid., 73.

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179 These successful campaigns to sell men therapies for their sexual neurasthenia were not confined to print advertising. Street side establishments with eye catching window displays, as they passed by on the street. An institute functioned with a museum like front, offering free admission to passersby. Located near railroads or waterfronts, they aimed to attract travelers. The firs t floor contained human images in various stages of disease. Further inside the museum, brightly colored wax Holbrook wrote dismissively about these museums, chalking t hem up to deceptive rackets designed to induce fear in its audience. There was a chain of them led by the Reinhardt brothers, one of whom graduated medical school, the other of whom was called doctor, but never was officially trained. The system was se t up to guide men through a fear inducing museum. At the end, the patron came to a dark class cabinet, drawing his attention closer. Then, before a captive audience, the cabinet would light 93 After this approached them and ushered them upstairs to the medical floor where they could purchase paid up to twenty. 94 powerful chamber of ying Custer. In the museum window at the street, a wax Custer lay near 93 Ibid., 77. 94 Ibid.

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180 death. His chest heaved, beckoning the curious observer to come inside and find out more about the fatal mistake at Little Bighorn. Again, Holbrook fails to acknowledge the potential for insight into the men who paid exorbitant amounts to enter these institutes, or who purchased sarsaparillas in hopes of reinvigorating a dulled sexual spirit. These examples show how th century, and particularly for consumers who could afford to purchase the cure. Many markers of ailing American masculinity were exemplified in the image of the Dying Custer. Whether the solutions offered inside the doors of the institute were medically sanctioned is less significant than the marketing strategy they used to lure men in: American manhood was under attack, perilously close to expiration, and in need of drastic and immediate care. Advertisements for these medicines extended the reach of the neurasthe nic discourse in urban spaces. Institutes brought men face to face with a reflection of their languishing gendered authority. They bombarded them with messages of manhood in peril, and presented them at the same time with culturally sanctioned natural so lutions. Considered by some to be distinct medical discourses, so called quack medicines coincide with messages propagated by physicians treating neurasthenia. In this view, sarsaparillas were not fundamentally different than milk diets proscribed by Dr. Nervous Diseases. All of these rest on the same assumption that the virility of American men dwindled in modern civilizations and promoted similar solutions: natural and delib erate attention to restoration. Doctors Making News Amid the cacophony of so called quack medicine lay more subtle, yet notable affirmation of credentialed physicians who treated sexual neurasthenia. The media coverage of prominent doctors was more subdued, bu t it provided a link between the hype and the medical reality. This

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181 link was clearly demonstrated in Philadelphia, where many men received treatment for sexual medical innovation, Philadelphia was the home of prominent physicians, hospitals, and professional meetings which handled sexual neurasthenia. Newspapers in Philadelphia but also s medical community, especially during the 1890s. The news coverage of Mitchell portrayed him as a quiet, esteemed physician with a penchant for literature. They spent little time on his background information, using his name without introduction. This suggests readers throughout The Petroleum Centre Daily Record e Northern Pacific 95 In the early 1880s, the Lancaster Daily Intelligencer credited for the end of life care of Governor Israel Washburn Jr. The coverage of hi s death reported the governor had 96 invoking the reputation that clearly required no explanation. 1890s. The Cambria Freeman reported in 1894 that Dr. S. Weir Mitchell led one group of Philadelphians who recommended the building of another state hospital to take on some of the 95 The Petroleum Centre daily record. (Petroleum C enter, Pa.), 06 June 1870. 96 Lancaster daily intelligencer. (Lancaster, Pa.), 14 May 1883.

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182 indigent insane who were being treated at the overpopulated Blockley almshouse. Mitchell charged against the opposing group, led by a homeopath of lesser repute, who lobbied for the constructio n of a homeopathic hospital. 97 His growing influence as a novelist crept into news The Evening Herald erial for his 98 A few years later, an article from The Scranton Tribune celebrated the high quality book store of Scranton and the locals who were hungry for the best modern fiction. Hugh Wynn to literature as an emblem of modern, must r ead fiction. 99 among other literary giants such as Rudyard Kipling, Right Hon John Morley, Teddy Roosevelt, and Booker T. Washington. Mentioned second after Kipling, Mitchell shared an ethos of writing serious liter ature with some of those still considered prominent members of the canon today. Unive rsity of Pennsylvania Alumni Association included Dr. John R. Mitchell of the medical ended another event 97 The Cambria freeman. (Ebensburg, Pa.), 07 Dec. 1894. 98 The evening herald. (Shenandoah, Pa.), 07 Oct. 1896. 99 The Scranton tribune. (Scranton, Pa.), 23 Aug. 1898. >

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183 affiliated with the university, and delivered a key toast. The Scranton Tribune recorded the event with highest praise for him: The list of those who will respond to toasts contains the names of men whose names are famous throughout the country and in some instances on both sides of the Atlantic. Notable among these is Dr. S. Weir Mitchell, of Philadelphia, world famous alike as a physician and as an author, besides being a member of the faculty of the university. The doctor is the wil 100 This form of reporting complemented the advertising for patent medicines because it was and that his reputation as a physician and writer was widely understood by the public. When patients went to select a doctor in Philadelphia, the positive connotation of Dr. Weir Mitchell reflected into the public view as legitimate, and his fame traversed national boundaries. Interestingly, the rhetoric used by advertisements in magazines like The Police Gazette is consistent with that of medical writings by Mitchell and Be ard. They are simply coming from sources with differing levels of professional esteem and thus warrant different credence by newspaper readers and historians of medicine, alike. While medical professionals in the late 19 th century as well as historians who have studied them draw a clear boundary between legitimate and quack medicines, the shared rhetoric used among them deserves serious consideration. While certainly Mitchell spoke from the pedestal of medical authority, he delivered very similar messa ges as the men in medical institutes who hid behind the Dying Custer. Those messages were: modern men experienced nervous and sexual debility as a result of the unique pressures upon them as Americans and as men. They 100 The Scranton tribune. (Scranton, Pa.), 27 Dec. 1899.

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184 were in need of sympathetic medical care, and could utilize any number of healthful remedies to restore vigor. Chief to all the treatment was sustaining a safe environment, where patients received privacy and medical justification of their concerns. Conclusion Sexual neurasthenia capture d the attention of men across the country in the 1880s and 1890s. Popular publications dispersed information about the disease, in its broad, generalized terms. Some sources invoked the reputation of neurasthenia by name, relying on its medical symptoms without casting blame on the ill individual. Others focused more on the sexual aspects, confirming that sexual illness was a medical condition free of shameful connotations. Together, this created a discourse of sexual neurasthenia that absolved the like s of Aaron Hershfield for failed marriages, criminal behavior, and mental weakness. It also opened a valuable avenue for men to connect their experience of anxiety and worry about their sexual health to a legitimate medical diagnosis and seek treatment. While historians seem to disregard a genre of magic cure alls with little historical value, I challenge the teleological presumption which undergirds this view. In fact, I propose that the most fruitful way to engage the historical record on medicines ab from the conversations about medical efficacy. This is particularly important for health concerns under the neurasthenia umbrella, because as Chapter 1 pointed out, the legitimacy of neurasthenia face d harsh challenges from some members of the medical field. If medical legitimacy of neurasthenic discourse either as a disease or a cure is removed as a metric for interpreting the health, vitality, and attitudes of actual men, then we begin to see a medi cal economy fueled by anxiety and fear. In the end, men spent lots of money on sexual remedies, and they turned up in the offices of Drs. Beard and Mitchell, downtrodden with worry about their

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185 sexual health. Sexual neurasthenia carried legitimate medical broader rhetoric in the media was culturally significant in the late 19 th century.

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186 CHAPTER 6 MEDICAL ABSOLUTION: CONSTRUCTING AND TREATING SEXUAL AND EMOTIONAL HEALTH PROBLEMS IN THE CLINIC Introduction In the lat e nineteenth century, men turned up in the clinics of the most acclaimed physicians in New York and Philadelphia, desperate for treatment for their neurasthenia. Many of them experienced sexual symptoms; many struggled with debilitating emotions; all beli eved the doctor was the right person to help them. Case studies and medical records show that doctors shameful, health concerns. Doctors doled out diagnoses o f general nervousness, neurasthenia, and sexual neurasthenia to describe a messy, varied set of experiences. This chapter relies on Infirmary for Nervous Disease s to explain what happened inside the clinic So far, this dissertation has shown how pervasive sources of information about It has also shown that lay medical literature, YMCA talks, medicine shows, and popular culture taught men to envision themselves as blameless victims of neurasthenia. Furthermore, these sources connoted neurasthenia with intelligence and civility; public portrayals of neurasthenia cloaked its three page list of s ymptom s with an air of respectability. For all the white American men who felt a muscular physique, or growing labor competition from immigrant and black worke rs: neurasthenia explained the struggle. 1 I have demonstrated that neurasthenia rhetoric 1 For more on the iconic image of bodybuilder Eugene Sandow, see David L. Chapman, Sandow the Magnificent: Eugen Sandow and the Beginnings of Bodybuilding (Urbana: University of Illinois Press, 2006); John F. Kasson,

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187 encompassed men across class lines, including day laborers numbed by mechanized factory work and professionals whose intellectual agility vanished under pressure T hus, I have shown how neurasthenia helped to collapse class differences and distill diverse experiences of nervous disease into a shared framework of neurasthenic manhood. Conspicuous by its absence, whiteness figured centrally in this calculus of healthy able bodied manhood. All of these cultural messages convinced men their condition needed medical attention. I argue the clinic served as a space for doctors and patients to negotiate the racial and gendered boundaries of healthy white manhood. Furtherm ore, I argue sexual and emotional My findings show the diagnosis itself mattered far less diagnoses of different symptoms followed no discernable pattern than the process of d isclosing and discussing the symptoms in the clinic. Relying on clinical records, this chapter shows men invoked neurasthenia rhetoric to articulate their agonizing worry over sexual health and function 2 The powerful cultural value of neurasthenia refrac ted into the clinic. It sick and compelled them toward medical treatments (as opposed to religious or self induced ones). In the clinic, doctors and patients negotiated a framework for recovery that emphasized the impermanence of physiological and behavioral symptoms. This provided a way to conceive of sexual dysfunction though a bodily experience, as one that could be unmade and retrained to be healthy, produ ctive, and even reproductive. I also ar gue that doctors attended to the emotional well being of patients well before it was fashionable to do so. Medical diagnosis of Houdini, Tarzan, and the Perfect Man: The White Male Body and the Ch allenge of Modernity in America (New York: Hill and Wang, 2001). 2 A Generous Confidence: Thomas Story Kirkbride and the Art of Asylum Keeping, 1840 1883 (Cambridge [Cambridgeshire]: Cambridge University Press, 1984).

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188 nervous illness, broadly defined, brought genital function and physical health under the broad umbrella of neurasthenia. As a result, men came to understand sexual dysfunction, histories of sexual indiscretion, and emotional strife as quotidian experiences of modern American manhood. In the clinic, neurasthenia (and its synonymous diagnoses) framed the patient as a sympathetic victim of circumstances and provided tangible ways he could adjust his environment abstinence, elixirs, diet changes -so his physical sexual problems could be transformed. This insight into the clinical treatment of neurast henia demonstrates a mutually constitutive relationship between culture and medicine in the Gilded Age. In this chapter, I will first show that men in Philadelphia selected their treatment ses over other local options. Then, I will explain the demographic data about the Philadelphia Infirmary of Nervous Diseases that shows the different types of white men who came into the clinic. They crossed age, ethnic, and class lines, making an archet ypal neurasthenic a sort of Everyman (every white man, that is). I will use representative exampl es from medical records and published case studies to expand the major findings from these sources: first, men came to the clinic already well read about neu rasthenia; second, the prevailing symptom which drove them to the clinic was worry; and finally, that disclosure about sexual histories constituted a core part of the intake process. I argue ecrets to the doctor was not only part of the diagnostic process, but also part of the treat ment. Doctors did pre scribe elixirs, rest, and changes in lifestyle, but they also provided the patient with a medical lens through which to view themselves as men This medical lens came without harsh judgment or shame; it cast masturbation and illicit sex in medically neutral terms; and it resolved the fear and anxiety that

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189 men felt. In short, the clinic offered men medical absolution from sexual indiscretions o r other behaviors unbecoming of men; and it reinstated their self concepts of healthy, white manhood. The Philadelphia Infirmary for Nervous Diseases: Men Who Sought Treatment from the Philadelphia Infirmary of Nervous Diseases, 1880s and 1890s Dr. Mitche they knew about its reputation and purposefully sought after the services available there. They had many other local options, given Philadelphia was a hub for medical innovation in the late 19 th century. Philad elphian s seeking healthcare enjoyed first rate medical facilities, which c onjoined a rich medical history to the nervous men rarely went to the other hospitals. In the 1880s and 1890s, S. Weir Mitc drove nervous men to the famed promotor of the rest cure. When they arrived in his clinic, they did so with conviction Other options existed, yet only small number of patients turned to them for treatment. The most famous was the first hospital in the United States, founded in 1748: Pennsylvania Hospital. While privacy laws about mental illness prevent researchers from knowing the details an hospital: they saw 254 patients between 1883 and 1894. 3 All of these patients received treatment free of charge. 4 It remains unclear how many of these patients were in sane which meant they would have been referred out for more long term care, and how many were treated on site for nervous illnesses. What we do know is that doctors believed insanity was constitutional and 3 Thomas G. Morton and Frank Woodbury, The History of the Pennsylvania Hospital, 1751 1895 (New York: Arno Press, 1973): 240. 4 Pennsylvania Hospital housed Dr. Thomas Kirkbride, who in 18 40 added prestige to the hospital as the newly appointed medical superintendent of the Insane department. He earned international renown for his groundbreaking sympathetic treatment of mentally ill patients during his career.

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190 inherited, therefore a patient could not be blame d for her own condition. 5 But they granted no compassion to diseases they associated with vice: doctors handled alcoholics with disdain and approached ethnic minority groups, specifically the Irish, with negative preconceptions. 6 It is likely the social conservatism of Pennsylvania Hospital informed a medical conservatism within the Outpatient Department of Mental Health and Nervous Diseases. Available Admissions and Discharges ledgers in the general hospital show very few uses of the popular diagnostic nervous illnesses appeared on record between 1891 and 1899. 7 Patients knew not to go here. A few blocks to the northwest, Jefferson Medical College erected its l arge hospital building on Samson Street. Despite difficulty accessing adequate funding and competition with Philadelphia in affording speedy relief to the sick and 8 Though it did not have a separate nervous ward like Pennsylvania Hospital, a small number patients at Jefferson received diagnoses and treatment for nervous illnesses. This was rare, but it does signal the phy sicians at the hospital understood and recognized nervous illnesses and could handle them when needed. 5 Led by Thomas Kirkbride w health patients. Kirkbride is credited for treating mentally ill patients with sympathy and marked a transition away from isolated incarceration, violence, and neglect that characterized early 19 th century hospital treatment of the insane. See Nancy Tomes, A Generous Confidence: Thomas Kirkbride and the Art of Asy lum Keeping. (1984). 6 Conversation with Stacey Peeples about Pine Street Hospital for the Sick and Injured, March 6, 2015. 7 Pennsylvania Hospital Records, Admissions Discharge, 1891 1899. For more information about Pennsylvania Hospital, see Thomas G. Morton and Frank Woodbury, The History of the Pennsylvania Hospital, 1751 1895 New York: Arno Press, 1973. 8 Gould, George M. The Jefferson Medical College of Philadelphia, Benefactors, Alumni, Hospital, Etc. ... 1826 1904; a History New York: Lewi s, 1904. 328.

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191 In 1873, S. Weir Mitchell founded the first and only facility that treated nervous illness in the United States. Aligning with the Philadelphia Orthop aedic Hospital, he established the Infirmary for Nervous Diseases on South Ninth Street. Initially two small rooms above Mr. lobbied intensely to expand the clin ic. 9 He reorganized the governing board to give physicians more control, and facilitated the expansion of the treatment of nervous patients. relationships he built with oth er physicians. In 1877, Dr. Charles Kasner Mills launched a department for nervous diseases at the Philadelphia General Hospital, and solicited S. Weir likely co c aptain for the project and the physician was drawn to the research conducted at hospital for some time. A former almshouse, and a generous charity hospital, it got saddled with unclaimed corpses and used them to for research and teaching. Motivated by th e wealth of information available through autopsy, Mitchell offered his support to make sure the neurological material at the hospital would not go to waste. A political battle between Mills and Mitchell and conservative leaders in Philadelphia emerged, a nd turned into a debate over funding; ultimately, Mitchell resigned from his formal affiliation with the hospital. However, Mills and Mitchell enjoyed friendship and professional development together. Mills attended conversational clinics and conferences was the hub for research and innovation, his influenced patients at Philadelphia General Hospital as well. 9 E.J. Pappert, "The Philadelphia Orthopedic Hospital and Infirmary for Nervous Diseases: America's Original Institutional Model of Neurological Study." Neurology 46, no. 2, (1996): 56004 56004.

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192 Additionally, Mitchell influenced medical students. He took his role as instructor serio usly and encouraged medical students to learn through clinical experience. As chapter two showed, f deserves further attention in this chapter because it served as a pl atform for training not only other physicians about nervous illness, but it shaped the subsequent generation of medical practitioners. While historians remember Mitchell for his famous rest cure, only some patients availed themselves of this treatment. The wealthier patients who could afford a lengthy stay often received the rest cure at the Philadelphia Infirmary for Nervous Disease over weeks or months. In the inpatient wing, private rooms housed nervous patients. Physicians kept a strict schedule, a nd they mandated silence, a regimented diet, and rest. 10 Most rest cure patrons paid hefty fees during their stay ; a bed in the nervous ward cost $4.75 per week ($122 today), and a private room cost $19.50 a week (over $500 today). 11 Hospital regulations reserved a few beds for and subsequent fame about the rest cure involved these in patients But in reality, these constituted only a minority of the cases. His torians have overlooked the outpatient ward, privileging the rest cure in their accounts. Those who could not afford long term care or whose cases did not require the rest cure were seen in the outpatient ward. As the hospital expanded, the treatment for nervous diseases separated from the orthopedic unit In fact, outpatient treatment of nervous diseases took place 10 Ibid. 11 These prices were recorded in 1905 a nd cited in E.J. Pappert, "The Philadelphia Orthopedic Hospital and Infirmary for Nervous Diseases: America's Original Institutional Model of Neurological Study." Neurology 46, no. 2, (1996): 56004 56004.The present day conversions were calculated comparin g 1905 with 2016 using

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193 in separate areas of the hospital. 12 Records from the outpatient ward provide valuable insight into how many different kinds of men with var ious symptoms sought treatment from the clinic. They ended up in the outpatient ward, instead of the inpatient ward, for one of three reasons: 1) they did not want to be admitted to long term care; 2) they could not afford an available bed or 3) there wa s no availability. While it is impossible to know exactly why a patient traversed the healthcare system as an outpatient, c ase histories and Admissions and Discharge Logs do offer important insight into the types of people sought treatment for neurastheni a in the 1880s and 1890s. Unlike rest cure patients, who shared socio economic privilege to afford time away from daily demands as well as the cost of treatment, men treated in the outpatient ward represented all social classes, ages, and types. Of cours e, they were all white as the clinics rejected non white patrons. The information gleaned from patient records shows among white men, a diverse group of people turned up for treatment. The intake of a patient at Philadelphia Orthopaedic Hospital and Infir mary for Nervous Diseases involved the primary physician, a resident, and then a nurse wh o scribed patient information. Four attending physicians regularly treated nervous patients: Dr. Wharton Sinkler, S. Weir Mitchell, Dr. Morris J. Lewis, and Dr. Fran cis X. Dercum. Each patient disclosed demographic information including name, address, age, occupation, nationality (in some cases, the absence of this information implied the patient was white and a Philadelphia native). The record book allotted a singl e page form to each patient, with demographic data at the top. Doctors first inquired about family history Unless pertinent family history existed, the record 12 E.J. Pappert, "The Philadelphia Orthopedic Hospital and Infirmary for Nervous Diseases: America's Original Institutional Model of Neurological Study." Neu rology 46, no. 2, (1996): 56004 56004.

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194 quest ions than men. This was the first inclination that medical attitudes about nervous illness had different scripts based on gender. allusion to sexuality appeared in term s of reproduction, marital status, and overall health. One six year old Christina Schellet was a widowed Danish Seamstress who lived in Philadelphia. Her person children all living. No miscarriages. St. Vitus Dance during fist pregnancy. Lost voice two 13 Another case provided more details about miscarriages and bi rth order. bouts with rheumatism, grippe, and bronchitis. Bo th of these women were diagnosed with emphasized their reproductive abilities. Even the health of a child after birth, as in the case of f scarlet fever indicates, reflected valuable information about a woman. Her role as a mother seemed to influence the medical assessment of her health. Her procreative ability seemed to provide clues to her current nervous state, and vice versa. In Phil saw three cases of masturbating women, but he dismissed it as rare, and as a function of youthful intimacy with servant girls. 14 Women never developed sexual neurasthen ia because doctors and patients These gendered perspectives 13 St. Vitus Dance was also called chorea, which described a neurological condition that involved impaired movement. 14 Beard, Sexual Neurasthenia, 201.

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195 shaped the conversation in the clinic. A negotiation between doctor and patient -the meaning of health and illness -spawned from this intera ction. Women and men sought treatment for neurasthenia at the Infirmary for Nervous Diseases and the process of admission was gendered. This fit contemporary perspectives over gendered nature of nervous disease. As I showed in chapter two some even ar gued neurasthenia was a for Nervous Disease: 537 women compared to 374 men between 1890 and 1900 at Philadelphia Orthopaedic Hospital. I have shown, however, t hat men suffered neurasthenia both medically and as a culturally significant reference point for flailing manhood. Medical records at the hospital show how intake procedure reinforced gendered expectations of the different experiences of nervous illness i n the clinic. For men, the personal history sections emphasized a much different set of gendered the opening line of questioning for male patients involved venereal disease, masturbat ion, and sexual habits. 15 For example, James Patton, a 20 year old Irish weaver, recounted, use of tobacco self abuse during early puberty but not persisted in long. No other sexual 16 11 years. Drinks and smokes a lot. Masturbation from 13 15 years old. None since. Used to 17 Both Patton and McPlosky were neurasthenic. These repre sentative examples demonstrate the hospital valued information 15 Alcohol and tobacco use, too. 16 Philadelphia Orthopedic Hosp ital Case Histories, 1890 17 Philadelphia Orthopedic Hospital Case Histories, 1890

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196 activity but remained ambivalent about reproduction Some records indicate the patient had children, but many only discuss parents and siblings in the family history. 18 None theless, neither as a father determined much about his overall health This shows that physicians viewed reproduction as distinct separately from sexual activity and the worry it induced. As chapters four and five argued, these messages circulated in wider popular culture. As chapter three showed doctors exchanged urgent pleas with one another to There are important rea focal point for this analysis. First, Mitchell used his post to train new doctors, so his work set a tone for the profession. Thus, knowing how he handled patients in the clinic helps illuminate how the wider profe ssion learned to treat male patients. Second, his clinic attracted the most neurasthenic patients; men knew about him, and they sought out his services on purpose. Third, along with George Beard, rasthenia and this information cascaded into less prestigious clinics across the country. One limita tion of these records lay in their specificity: not all hospital records survived. Some patients appear only on Admissions and Discharge ledgers, whereas others have full patient histories available ; some appear in both places. Some years are missing altogether. In other words, the data from the two groups of sources, ledgers and patient records, sometimes overlapped, but were mostly extensions of one an other. Some items in the patient records that were not listed in the ledgers, and vice versa. This source material provides demographic data of up to 428 patients seen at the clinic between 1890 and 1900 First, I will explain the demographic data and its impl i cations. Then, I will use full records from the Infirmary for 18 This silence su ggests either the patient did not have children, or the physician did not inquire about his children.

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197 Nervous Diseases and case studies from Dr. Beard to bring the nervous illnesses, innermost fears, and concerns about sexual health to life It is within t he context of this demographic information that I analyze patient records from 1887 1892. I draw from 91 full medical records involving patients with nervous disease who were seen at the Infirmary for Nervous Disease. While only a small portion of the re cords survived for analysis, they can be viewed within the larger context of the demographic data described above. Additionally, and more importantly for this dissertation, individual patient the doctor patient interaction, and the outcome of the clinical experience. Read together, the demographics from the Admissions and Discharges provides a broad overview of the patients and their diagnoses; the patient records offer more specific data and emotional well being. clinics. F.G. Gosling argued that medical professionals across the United States e mployed similar approaches to nervous illness: they defined, encountered, and treated it in ways consistent with Mitchell and Beard. So while Philadelphians opted to see Mitchell instead of a non specialist at Jefferson Hospital a few blocks away, this do was unique. In fact, patients in the South and West read and wrote similar case studies in medical journals as the urban professional elite in the North. Rural patients bore many resemblances to the nervous men in ci ties. In addition, small time family physicians treated neurasthenia using the same (varied and vague) processes as their urban counterparts. It is likely, then, that physicians across the country treated sexual and emotional components of neurasthenia i n a manner consistent with the findings of this dissertation The patient records

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198 Age. Overall, the men diagnosed with some form of nervous disease in the Inf irmary for Nervous Diseases were native born residents of Philadelphia in their twenties and thirties. As Table 5.1 shows, ages ranged widely. Two cases of nervous illness occurred in three year old boys; the oldest was 66. Medical and popular writing a bout neurasthenia often distinguished However, in clinical practice, doctors used the general diagnosis of neurasthenia most often: 244 men were diagnosed w ith neurasthenia. 19 Only two other forms of the disease appeared on record: sexual and cerebral neurasthenia. Only one person received a diagnosis of cerebral neurasthenia in ten years. But many 107 men were diagnosed with sexual neurasthenia. At the m ost prestigious clinic treating nervous illnesses at the time, sexual neurasthenia was the suffering among men. 20 They did, indeed, experience sexual health pr oblems, and they turned to Doctors often omitted the diagnosis on the patient record itself, so what stands out about records c ontained no diagnosis. 21 Only 12 listed the diagnosis as sexual neurasthenia and 8 as neurasthenia. Seven patients were diagnosed with hypochondriasis (including two with sexual 19 A few patients suffered general nervousness (17) and hypochondriasis (15). These terms described symptoms similar to neurasthenia. The patient records do not indicate substantial differences among them. 20 In addition, this data intervenes in a historiographic conversation to highlight the significance of sexual and emotional health of neurasthenics. 21 When possible, I read the ledger against the patient records and noted the diagnosis listed in the ledger. If that data was not available, I counted the record as having omitted the diagnosis.

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199 hypochondriasis), a broadly defined disorder that often resembled neurasthenia 22 The remaining diagnoses varied widely to include nervous dyspepsia, vertigo, meningitis, two cases neurasthenia and sexual neurasthenia were the most com mon diagnostic categories for nervous illnesses. 23 As subsequent analysis of the individual patient records will show, sexual health concerns permeated neurasthenia cases; a general neurasthenic often discussed his sexual concerns with his doctor ; and som e times, sexual neurasthenia case records hardly mentioned sex So, diagnosis with sexual neurasthenia alone does not reflect the significance of sexual matters to th century. However, the prevalence of sexual neur asthenia as a distinct, recognizable diagnosis shows Mitchell took the symptoms and the disease seriously. He did not dismiss it as prurient but upheld it as a legitimate medical condition worthy of medical attention. His example influenced his patients, fellow colleagues, and the medical trends of the Gilded Age. The sexual and health histories of the men in the uncertainty. Luckily, their doctors offered treatmen t for these emotional health problems along with the physical ones. Through the lens of neurasthenia, physicians provided a holistic being. The next sections explore surviving patient records from 1887 to 1900 at the Infirmary of Nervous Diseases. These are much more descriptive than the Admissions and Discharges logs 22 Vladan Starcevic and Don R. Lipsitt. Hypochondriasis: Modern Perspectives on an Ancient Malady (New York: Oxford University Press, 2001): 6 16. 23 While conducting research, I intentionally sorted out the cases that expressly resulted from injury or were designa ted otherwise physical manifestations of nervous disease, such as railway spine.

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200 from which the demographic data was drawn. Through the lens of the clinic, we can see an individual suffering man negotiate d meanings of race, gender, and health wi th his sympathetic doctor; we can see the social and professional pa radigms about healthy manhood ca me to bear on their interactions. In the end, each side benefited from the clinic visit: the patient is absolved of his affliction and the doctor gets a s alary (and, perhaps a compelling case study to present at the American Neurological Association): manhood redeemed. The Informed Neurasthenic Patient Patients waited a long time before coming to see the doctor. Many disclosed to their doctor they had been suffering a few months with their ailments, but most coped with symptoms for a matter of years before coming to see the doctor. Due to the popularity of less professionally sanctioned treatments, such as mail order elixirs found in the pages of the P olice Gazette, it seems men tried to self medicate before resigning themselves to the doctor. Considering the length of suffering ranging from three months to twenty years I argue that men viewed the doctor as a last resort. The length of suffering mat tered for the medical record. Almost half of the men who received a neurasthenia or related diagnosis between 1887 and 1892 stated expressly the amount of time they had suffered prior to coming for treatment. 24 Most of them suffered significant amount of time, in fact. Nearly half of those who reported a timeframe stated they had symptoms for one to three years. One fourth reported four to ten years of ill health. One man dealt with sickness for 20 long years. Some periods of illness were shorter: One in five men reported less than a year of symptoms. The shortest time period was three to four weeks. The 24 Forty one indicated specific time ranges in weeks, months, or years. Two more gave a vague indication they had

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201 overwhelming majority of men, however, coped with their symptoms for over a year before turning up at the Infirmary for Nervous Diseases. The rea sons for this can be speculated A private facility dedicated to assisting the indigent, the Infirmary for Nervous Diseases did not turn away patients who could not pay. So, what drove them to decide to seek help from a doctor? It was rare when a patien t reported prior treatment for their nervousness. In each case, the prior treatment proved inadequate. Walter Holt traveled from Wilmington, Delaware with a desperate hope Dr. Mitchell could help him. The eighteen year old came from a family of nervous people, some of whom died from their conditions. Walter received treatment from a homeopathic doctor for two years prior to coming to Philadelphia. He even spent three weeks as an in patient at Wilmington Homeopathic hospital, but to no avail. He came t o the Infirmary for Nervous Diseases looking for effective treatment. 25 Another man, Stephen Ryan, a laborer from Philadelphia, overcame two rounds of unsuccessful treatment. First, he found temporary relief from his nervousness due to treatment at Erie M edicals Co. But after a month, symptoms returned. He then went to Marston Medical Co. and reported maltreatment. His symptoms recurred. 26 A third patient, Hugh Cole, had seen another Philadelphian physician ten years prior, Dr. Samuel Gross to address a stricture in his urethra. 27 Finally, Gaspar Arnaiz, a married salesman, age 55, had been committed to the 28 Instead, he brought his 25 Philadelphia Orthopaedic Hospital and Infirmary for Nervous Diseases: Case histories; ca. 1872 ca. 1942, (#000108031). Vol. 10, p. 445. 26 Philadelphia Orthopaedic Hospital and Infirmary for Nervous Diseases: Case histories; ca. 1872 ca. 1942, (#000108031). Vol. 16, p. 510. 27 Ibid., 513. 28 Philadelphia Orthopaedic Hospital and Infirmary for Nervous Diseases: Case histories; ca. 1872 ca. 1942, (#000108031). Vol. 15, p. 111

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202 worries to the team the Infirmary for Nervous Disease fo r treatment. 29 These patients stand out of treatment failed them, and they now embarked on something new they hoped would help them. Other patients who may no t have sought prior treatment certainly knew a lot about neurasthenia. Some could readily identify the etiology of their illness. The case of Alfred W. Goft illustrates the degree to which patients applied medical language to their experiences and articu lated their condition using terms affiliated with neurasthenia. Goft came from New Jersey, and brought a loaded history of nervousness in his family as well as a lifetime of weakness and injury. He reported to Dr. Lewis at the Infirmary for Nervous Disea se that he had fallen and 30 He reported bouts of nervousness for an entire year before that. He came to the doctor that September because of two r man, John B. Sharp, attributed his n ervous and sexual symptoms to a and broke nervous illness appeared. Sharp spoke about general problems like nervousness and indige stion. continued working in carpentry, he felt 29 One patient record indicated the patient had been treated at the Infirmary once before. He followed treatment and returned a year later with new symptoms. Philadelphia Orthopaedic Hospital and Infirmary for Nervous Diseases: Case histories; ca. 1872 ca. 1942, (#000108031). Vol. 10, p. 97 30 Nervous sh ock became widely understood as an outcome of a traumatic event by the late 19 th century. See Michael R. Trimble, Post Traumatic Neurosis: From Railway Spine to the Whiplash (Chichester [West Sussex]: Wiley, 1981).

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203 Overall, Sharp acknowledged the root cause of his current state, and told his physician that he [ed] the 31 Another patient, James McPlosky, had been reading about nervousness attacks and then to the Infirmary for Nervous Diseases. 32 Finally, some men attributed t heir current conditions to their sexual pasts. A clergyman from Delaware named George E. Wood spoke with Dr. Mitchell about his sexual concerns. masturbation. Has not been constant ever since one to two a week sometimes more frequent 33 Reverend Wood clearly knew about the medical connections between a 22 year old railroad brakeman named John Holzer came to the Infirmary in 1891 with a clear sense t hat his nervous symptoms connected to his sexual health. He discussed his nervousness, on him. Thinks his Holzer exemplifie d the informed patient. Young and working class, Holzer managed to accrue information about sexuality and nervousness perhaps from the pages of the Police Gazette cal lecture. Emboldened by this knowledge, Holzer concluded on his own his emotional instability resulted from illicit sexual activity. 31 Philadelphia Orthopaedic Hospital and Infirmary for Nervous Diseases: Case histories; ca. 1872 ca. 1942, (#000108031). Vol. 16, p. 262. 32 Ibid., p. 43. 33 Ibid., 291.

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204 A few men reported self medicating prior to seeking professional care for their nervous disease; two of the cases in volved explicitly sexual concerns. Gas Furney, a 28 year old weaver, claimed to use acid phosphate to successfully eliminate the occurrence of nighttime emissions. 34 A tinsmith named S. S. Craig reported taking bromide and valerian to help quell obsessive thinking about previous sexual exploits and ease him into him sleep. 35 Another case involved a 31 year old clerk named W. H. Ebright who demonstrated a keen awareness of the various treatments available to him. Formerly treated by another doctor for typh oid and grippe, Ebright informed the attending physician that he used to take bromides, but had stopped taking them body. 36 These examples show some patients entered the Infirmary for Nervous Diseases already neurasthenia symp toms and treatments with their sexual health. Men curated information from other sources and arrived in the clinic with a clear idea of what ailed them and how to treat it. At the same time, their own estimations proved inadequate. They still needed the doctor to field their symptoms and assess their condition. So, even for men who demonstrated a strong handle on the information about sexual heath and nervous diseases they still felt it was necessary to seek professional treatment. For them, the clini c offered something they had not found on their own: a meaningful, empathic interaction with a doctor. 34 Philadelphia Orthopaedic Hospital and Infirmary for Nervous Diseases: Case histories; ca. 1872 ca. 1942., (#000108031 ). Vol. 15, p. 133. 35 Ibid., 276. 36 Mitchell commonly recommended milk to help patients regain strength. Information about the rest cure and Fat and Bl ood and how to Make them.

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205 The allure of the sympathetic listening ear of a trained professional appealed to lots of patients who had spent months or years battling nervous dis ease. A small number of experienced a sharp increase in symptoms and hurried to the doctor for treatment. However, the majority suffered chronic symptoms for months or years and finally decided to show up at the doctor. What caused them to eventually r As previous chapters argued, these men absorbed the ubiquitous cultural information about rampant cases of nervous, fatigued men; and they internalized messages about the harms of youthful masturbation a nd persistent sexual excess. These messages whether medically informed or merely advertisements for quacks successfully convinced men to see themselves as ill and to seek medical treatment for their disease. One of the key reasons neurasthenia requi red a doctor was because its obscure and lengthy list of symptoms made diagnosis difficult. Also, u nlike injuries or tumors, nervous diseases required certain degree of self reflection to identify. Dr. Francis Dercum, a physician at the Infirmary for Ne neuroses to introspection to analysis of symptoms, to self 37 Nervous men often indicated they had been thinking about their symptoms extensively prior to visiting a doctor Dr. George Beard believed this quality actually exacerbated the emotional turmoil of nervous diseases. By the time patients arrived in the clinic, their symptoms multiplied on themselves, and they had become the focus of intense obsessive personal scru tiny. Doctors found themselves pressed to negotiate sexual and emotional health questions that men had been mulling over for quite some time. 37 Francis X. Dercum, Rest, Mental Therapeutics, Suggestion (P. Blakiston's son & co, Philadelphia, 1903): 256.

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206 The worry men felt was compounded by shame and uncertainty. A middle aged m an his name. He was a teacher and a part his sexual debility had, so to speak, dislocated his whole life the sullen man spoke to Dr. Beard timidly. He described serious memory loss and difficulty concentrating for long. He also indicated semen came away when he urinated. Dr. Beard asked about masturbation history and lea 38 This case epitomized the ways in which pervasive rhetoric about debilitate d manhood weighed on individual men it besieged them with information, clogging their ability to separate lies from medical truth. George Beard wrote impassioned pleas to doctors about the nefarious impact of inac cur ate medical information about nervousnes s. He found that medically inaccurate nervous woes to their early indulgences, even when there is no clear proof of any connection 39 Most, with treat ment, would recover entirely. They key is for the physician to provide comfort through diagnosis, to quell the anxiety regarding sexual questions, and to not to exacerbate nervousness with worry about the nervousness. Patient records teemed with the cutti ng fears that men hoisted upon their doctors. As an aggregate, these sources reflected the worry, anxiety, and helplessness men felt Sexual 38 New York Medical Record, 15. No. 4. (Jan 2 5, 1879): 73. 39 Ibid., 74.

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207 symptoms exacerbated their emotional turmoil Because the sexual component of nervous illness afflicted only men the conversations about sexual histories and concerns for the future reflected the attitudes men held about themselves as embodied individuals. In other words, k now about sexual health so they could have it for themselves. In the clinic, the special designation of sexual neurasthenia mattered in name only. Most men who came into the clinic mentioned their sexual lives in some way, and many drew clear connections between their present conditions and their sexual histories. That sexual neurasthenia did not stand out as a particularly distinct disease from neurasthenia is a compelling mirror to the larger cultural significance of the neurasthenic man. For leading physicians of neurasthenia, the distinction did not matter: sexual and emotional troubles occurred so commonly that the two diagnostic categories collapsed together. 40 This finding is significant because it refracts into the cultural representations of neu neurasthenic symptoms, including the euphemistic language about loss of vitality and weakness, did include sexual and emotional components. When patients came to discuss their health with their doctors, they relied on a broadly defined language of manly debility that conflated nervousness, weakness, and sexual dysfunction. All of these things comprised an aggregate of manly troubles white men faced at the end of the nineteenth century. The loo ming specter of neurasthenia instilled significant fear into men that their bodies were not fit for work, reproduction or marriage and this made them very worried. 40 This supports a claim that in popular culture and advertisements for lay medical treatments, neurasthenia

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208 neurasthenia characterized by acute sexual symptoms. However, medical records show that in practice, sexual symptoms did not determine a diagnosis with sexual neuras thenia. In fact, many men with sexual symptoms received the general neurasthenia diagnosis. For example, Hugh Boyle, a twenty two year abuse at 10 years and stopped it 5 years ago but As a teenager, Boyle masturbated, but stopped because he believed it was a harmful behavior. The potential consequences of his actions weighed on him for five years. He grew weak, lost all energy including considering his case, Mitchell diagnosed Boyle with neurasthenia. He proscribed an elixir containing sulfur and strychnine, a common sedative used for nervous diseases. 41 Though his more general neurasthenia. Conversely, men with general, non sexua l symptoms got diagnosed with sexual neurasthenia. Alfred Goft, the Armenian printer from New Jersey discussed earlier, described his broken jaw, headaches, nervousness, and trembling. He mentioned nothing about sexual dysfunction. Even a history of mas turbation or venereal disease or lack thereof is absent. interesting that this is missing from this case. Furthermore, Dr. Lewis diagnosed Goft with 41 Hugh Boyle. Philadelphia Orthopaedic Hospital and Infirmary for Nervous Di seases: Case histories; ca. 1872 ca. 1942. (#000108031). Vol. 16, p. 42.

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209 sexual ne urasthenia, despite the fact his entire medical history contained no information about developed from traumatic injury (not a history of illicit sexual behav ior) and manifested in symptoms that prevented him from going to work (as opposed to symptoms that afflicted sexual health). The prevailing concern among men at the Infirmary for Nervous Disease was worry. A 30 year 42 Another man, 43 The compounding effect of introspection medical treatises showed up in clinical reports. A part timer farmer, nd 44 Worry, nervousness, lost confidence, depression: these symptoms dominated the clinical assessment of ments: the onset of general one feared the loss of agency over their emotional and physical well being. Nervous illness threatened the very qualities that consti tuted a healthy white patriarch in the Gilded Age and men turned to doctors to air their frustrations. 42 Ibid., p. 98. 43 Ibid., 100. 44 Ibid., 114.

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210 records portray the clinic as a place where physical and emotio nal struggles intertwined. For the ill, the mind physical and emotional sensations worked in tandem. A traumatic event caused injury, and the injury from the trauma caused nervousness; worry about both of these things perpetuated the nervousness and materialized in the form of sexual dysfunctions. Men explained their fears using the cultural framework of neurasthenia. In this process of sharing and listening to emotions, b oth parties lay patient and trained professional mutually applied the language of neurasthenia and manhood to the situation. Doctors listened with sympathy, and applied a form of medical exoneration for their struggling patients. One area in particular that generated enormous concern for men was marriage. In New York City, Patient XX told Dr. George Beard he desired to marry but felt he needed medical advice and treatment to prepare himself. Similar to standard procedure at the Philadelphia Infirmary f Mitchell, Beard recorded masturbatory habits and sexual experiences. Patient XX said he began masturbating at age 16, after which followed a period of sex with women. Since about age 20, however, the man abstained from sexual activity and lost his sexual appetite. Now 40 and in treatment focused on the genitals: he administ ered alternating treatment to the urethra including electric shock and sounds. The patient also took strychnia, zinc, and chloride of gold, a tincture commonly dispensed at the Philadelphia Orthopaedic Hospital. Beard concludes his report by

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211 improvement was sufficient to warrant preparation for marriage. 45 Sexual debility, for sexual neurasthenics, required appropriate treatment before marriage could be attained. The anxiety over marriage eligibility affected younger men also. A twenty two year old hard working mechanic had been referred to Dr. Beard by a mutual acquaintance. The young symptoms of ill health; his body was strong and healthy. However, worry and fear of sexual makes an aside about traditional medical diagnosi s of this case. This case would have been ssed the anxiety. Beard affirmed objective, easily demon strated, and clearly flowed from the irritation of the genitor urinary 46 being patient gave this man a more specific and accurate diagnosis. Worry about sexual performance and marital f uture Married men worried their marriage negatively impacted their sexual health. The case of Edward Thomas exemplified the emotional tax marriage took on men who came to the clinic. His worry centered on the inclination that marriage somehow polluted his sexual drive. Thomas traveled over thirty miles from Wilmington Delaware to seek treatment at the Infirmary for Nervous Diseases in July 1890. Though h reported feeling is physical debilities included headache, backache, poor appetite, 45 Beard, Sexual Neurasthenia, 167. 46 Ibid., 191 2.

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212 and dreamful sleep. Despite these symptoms, he remained sexually active : he told Dr. Sinkler that he masturbate d as a boy and contracted gonorrhea a few years ago all evidence of an engaged sexual appetite. Once he got married, however, his interest in sex plummeted. He told Dr. Sinkler he felt 47 The medical report yet found himself overcome by concerns that his marital bed had been afflicted by nervous disease. bachelor; rather, even those who wer e, as Dr. George Beard described, married may be great sufferers from sexual neurasthenia 48 Worry consumed men like Thomas and compelled them to seek medical help to deal with it. The concerns about being ready for marriage echoed in the broader culture these patients engaged. As chapter four argued, popular culture teemed with metaphors e quating marriage to enslavement and positive portrayals of rogue men who escaped the marital pincers of treacherous women. Modern marriage instilled fear in men a fear in a loss of control and autonomy that white men wrote and read a lot about in the Gil ded Age. They talked about it a lot, too. As chapter three discussed, the YMCA taught young, unmarried, white men that moral purity in the present promised marital happiness in the future. Medical talks fused religious and scientific evidence to support the psychic toll sexual vice, in particular, would take on their future selves. One speaker threatened that past vice would forever haunt a man because it meant he would never be able to know how truly happy he could have been had he remained morally pur e. Men 47 Philadelphia Orthopaedic Hospital and Infirmary for Nervous Diseases: Case histori es; ca. 1872 ca. 1942., (#000108031). Vol. 16, p. 65. 48 Beard, Sexual Neurasthenia 151.

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213 happiness? If so, what was the point of trying anyway? These questions, and the cacophony of answers attempting to answer them, left white men without a clear trajectory to happiness. They felt overcome by worry, debilitated by uncertainty, and physically incapable of harnessing control over their futures. The cli nical experience offered men a way to regain control. isolation when it came to inadmissible topics about sexuality. M en for whom sexuality lay outside the boundaries of proper discussion or behavior, frank conversation about sexuality could impotence or erectile failures simult aneously alerted men to the ubiquity of the problem and placed their own experience amid many other confusing and potentially quack medical paradigms. How could a man know which messages to trust? There were so many messages vying for his attention and h is dollar. The challenge to identify the appropriate diagnosis and treatment for men with sexual health concerns remained significant despite the popularity of public information about it. Neurasthenia famously contained multitudes: symptoms so common an d so diffuse they could happen to anyone, yet they could not be diagnosed without careful assessment by a professional. Thus, the worry about sexual matters that preoccupied more than half of the patients in this study drove men to disclose sexual histori es to their doctor. From these cases, I draw two important conclusions: first, men commonly struggled with insecurity about what constituted normal, healthy sexual behavior; second, the clinic served as a check to measure their own experience up against

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214 sexual indiscretions into a framework of neurasthenia and could use the disease framework to separate themselves from their previous indiscretions. I call this medical absolution. Nineteenth ce However, by the end of the century, some rejected the belief that the practice necessarily led to insanity or blindness, the medical community cautioned against the obsessive potential for masturbation. 49 It would not be until the early twentieth century that scholars discovered masturbation across human populations and in animals, and therefore declared it a part of a univers al sexuality. 50 Beard wrote that youthful understood by the profession. 51 The morality of masturbation and the health consequences tied to that morality was still being sorted out in the 1880s and 1890s. Patient records show it individual consultations between doctors and patients figured centrally in this negotation In the clinic, doctors regarded the healthy boundaries of appropriate masturbation with ambivalence; the conversations in the clinic moved them from private, shameful matters, out into open, medical dialogue. More than half of men dealt with sexual concern s, most of which included some disclosure about a history of masturbation. As I argued earlier, this discussion of sexuality did not determine a particular diagnosis or treatment. Instead, it was a routine, common their health concerns. I argue the act of disclosing 49 Thomas W. Laqueur, Solitary Sex: A Cultural History of Masturbation. (New York: Zone Books, 2003): 64 66. 50 Philadelphia Orthopaedic Hospital and Infirmary f or Nervous Diseases: Case histories; ca. 1872 ca. 1942, (#000108031). Vol. 16, p. 65. 51 New York Medical Record, 15. No. 4. (Jan 25, 1879): 73.

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215 the clinic offered. That symptoms disappeared when doctors gave them a name any name and a treatment an y treatment shows the relative insignificance of the precise diagnosis. Instead, the authoritative knowledge of the doctor lent credibility to what men already intended to do: reframe their sexual lives as healthy and normal. 52 Because of the historic al significance of masturbation to overall health, one of the first discuss masturbation only in the past tense. Some described it as a childhood endeavor. For exa 53 54 Others may have continued the habit into adulthood, but still distanced themselves from their current condition and their sordid past. For example Joshua doctor would consider this matter while diagnosing him. Y et he also attempted to present his current condition as abuse free, and to characterize masturbation as a function of a different claim and suggests the doct 52 The phrase authoritative knowledge is commonly used in scholarly and activist circles about birthing processes. For more on the concept, see Carolyn Fishel Sargent, Robbie Davis Floyd, and Inc NetLibrary. Childbirth and authoritative knowledge: Cross cultural perspectives (Berkeley: Univ ersity of California Press: 1997). It signals the relative power one knowledge body assumes over other, equally viable knowledge systems. In the case of birthing, the concept helps elucidate the rising status of medicine as a scientific practice which va ulted the physician into a position of authority over a midwife. See also: Leslie Reagan, When Abortion was a Crime: Women, Medicine, and Law in the United States, 1867 1973 (Berkeley, CA: University of California Press, 1997): Chapter 3. 53 Philadelphia Orthopaedic Hospital and Infirmary for Nervous Diseases: Case histories; ca. 1872 ca. 1942, (#000108031). Vol. 16, p. 65. 54 Ibid., 82.

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216 their masturbatory habits as being part of their personal histories but no longer present conditions. This distancing language indicated another way patients invoked broader popular medical wisdom in their clinical treatment. They wanted to apprise their doctor of their masturbation habits without having to claim any current responsibility to them. Popular rhetoric granted that childhood masturbation could be attributed to youthful excitability and left few permanent scars if discontinued into adulthood. When men promised, like James McPlosky did, that he lied to his doctor about hav ing continued. 55 Either way, McPlosky demonstrated his familiarity with the conventional medical wisdom. Furthermore, he presented himself as someone who, though unable to completely to resist the urge during his youth, found ways to restrain his sexual a ppetite in adulthood. The record of George Fox lacked chronological precision: it simply stated 56 the repeated use of distancing was it really the case that men routinely ceased sexual behavior for several years before seeing their doctor? It is more likely they used this narrative device as a way to explain themselves to their doctor without making a full disclosure about present masturbation habits. However, for others, masturbation lay at the center of their current health problem. Hugh Boyle, a neurasthenic patient discussed in the prior sec tion, obsessed about the time he 55 Ibid., 43. 56 Ibid., page unknown.

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217 haunted him into adulthood. 57 Ano ther patient named Gilbert Rooms also connected his sexual now for 2 58 His own reporting of the present condition linked his prior habits to his current symptoms. Some men readily admitted their sexual habits continued into their present moment. stoppe 59 While the discussion of masturbation overwhelmingly involved men distancing themselves from their pasts, their relationship to sex with women varied. Some men distanced themselves from non marital sex with women, too, casting that behavior into a shadowed past divorced from their presentation of a more restrained and worried self to the doctor. For example, McPlosky reported that, in addition to his teenage masturbation 60 Another man, though married, declared he participated in 61 One person pinpointed their sexual life at a vague, but e past] had desire for excessive sexual intercourse 62 However, other men characterized their sexual activity with women in m 57 Ibid., 42. 58 Gilbert Rooms. Philadelphia Orthopaedic Hospital and Infirmary fo r Nervous Diseases: Case histories; ca. 1872 ca. 1942, (#000108031). Vol. 15, p. 294. 59 Philadelphia Orthopaedic Hospital and Infirmary for Nervous Diseases: Case histories; ca. 1872 ca. 1942, (#000108031). Vol. 16, p. 407. 60 Ibid., 43. 61 Ibid., 231. 62 Philadelphia Orthopaedic Hospital and Infirmary for Nervous Diseases: Case histories; ca. 1872 ca. 1942, (#000108031). Vol. 15, p. 276

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218 his bachelorhood, h 63 A married 64 with women. Still others lacked any experience with intercourse at all. Though they may have histories came under scrutiny unlike masturbation cases, do ctors did not accuse patients of marital sex nor condoned it. They treated it as The stigma associated with masturbation, which still floated inside the clinics for nervous diseases, did not attach to intercourse. These records show that men, regardless of age, marital s tatus, or social class, did and were expected to, engage in sexual activity. The other most common bit of sexual information found on patient records was venereal disease. No patient in the infirmary sought care for venereal disease for it was consider ed a somatic condition, not a nervous one. Patients were aware of this, and did not expect to receive treatment for syphilis, gonorrhea, or chancres on their genitals. But they did mention it. The fact real disease bears noting in this context because past based on his relationship to venereal disease. Some of the information appeared on the 63 Ibid., 291. 64 Ibid., 175.

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219 record in a matter of 65 once 66 67 Some reported disease history bore no sign of suspicion or questioning by th e nurse 68 69 Frequently, the record specified that men denied syphilis, specifically. 70 In the most telling case, 71 While we cannot know what motivat ed doctors to accept some personal histories at face value and coating others with suspicion, we do see how doctors brought their expectations to bear on the clinic visit. The judgement laden language used to describe masturbation and venereal disease d the patient and the doctor. When a patient declared he had no venereal disease history, the 65 Ibid., 291. 66 Lewis Deihliuan. Philadelphia Orthopaedic Hospital and Infirmary for N ervous Diseases: Case histories; ca. 1872 ca. 1942., (#000108031). Vol. 16, p. 32. 67 Ibid., 19. 68 Ibid., 98. 69 Ibid., 513. 70 The reason for this is unclear, though I speculate it may have to do with the affiliation of syphilis with insanity. For more o n this see Deborah Hayden, Pox, genius, madness, and the mysteries of syphilis, (New York: Basic Books, 2003); and John Parascandola, Sex, Sin, and Science: a History of Syphilis in America: (Westport, Conn: Praeger, 2008). 71 Gas Furney. Philadelphia Ort hopaedic Hospital and Infirmary for Nervous Diseases: Case histories; ca. 1872 ca. 1942., (#000108031). Vol. 15, p. 133.

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220 take process brushed against moral issues. This challenged any propriety that may have erience with sex that would expose him to venereal disease Overall, non marital sex and masturbation were typical behaviors among white men of middle and working classes in the 1880s and 1890s. 72 Doctors knew this, and even when a patient could not muster the courage to talk about it, the way they took down the information implied that most men engaged in illicit sexual behavior. The types of sexual behavior, and the chal lenges men encountered related to sex and reproduction frequently came up in the conversation. This typically involved part of a present condition or regular practice. Distinct from masturbation or previous illicit sex, which most men knew it would be ap signified they did not have a clear understanding of the boundaries between healthy and unhealthy sex and body functions. For this reason, the clinic visit was so important. It offe red a space for men to first demonstrate their knowledge of neurasthenia rhetoric and create safety in recognizing a shared knowledge with the doctor. Once in that safe, shared space, worried men exposed their uncertainties about sexual health. The type s of concerns men brought to the clinic varied. 73 One representative example was Henry Heritage. He described his history and symptoms to Dr. Mitchell: Heritage started masturbating when he was 12 or 13. He claimed to relinquish the habit at 17, and at age 20 he 72 Here I am reading the sex that causes a man to contract venereal disease as any form non marital sex. 73 However, they all involv ed solo sexual encounters or intercourse with women except one involving sodomy.

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221 74 These symptoms lingered for several months before Henry decided to see a doc tor. Panicked, Heritage told Dr. years old, and otherwise healthy and robust, Heritage confronted Mitchell with grave fear his sexual history obliterated any chance of a healthy sexual future. Echoing sentiments from the YMCA medical talks, Heritage hoped Mitchell could reframe his condition with the promise of a viral future. findi ng. Late nineteenth century physicians, such as those who gave Medical Talks at the YMCA, urged men to unlearn the association between masturbation and nighttime emissions. reproductive resources and signaled illness. That view changed by the close of the century, and doctors began to view emissions as regular functions of the body. Physicians in the Infirmary for Nervous Disease embraced this modern view, and considered c onditions of emissions as incidental and not concerning. The majority of men did not mention emissions as a symptom. However, men who experienced them gave specific details about their emissions they paid attention to the frequency and circumstances to r 75 An 18 76 A married 55 year 74 Philadelphia Orthopaedic Hospital and Infirmary for Nervous Diseases: Case histories; ca. 1872 ca. 1942., (#000108031). Vol. 16, p. 19. 75 Ibid., 421. 76 Ibid., 455.

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222 77 3 78 Men wh o cataloged their emission schedule typically also kept close count on their masturbation habits. They paid careful attention to frequency and often connected the two behaviors together. Clearly, they had not yet been convinced that emissions were normal so they brought their concerns to the doctor for appraisal. Married and single men talked with their doctors about their sexual experiences with women. Mostly, married men implied their health concerns affected their wives, though one alluded to having 79 A well educated, sexual history included childhood experiences of be coming aroused while tree through the act without the presence of a female or actual ab on his emissions. He experienced a reprieve from emissions after marriage, but they soon mental labor and mental exciteme 77 P hiladelphia Orthopaedic Hospital and Infirmary for Nervous Diseases: Case histories; ca. 1872 ca. 1942., (#000108031). Vol. 15, p. 192. 78 Ibid., 90. 79 Philadelphia Orthopaedic Hospital and Infirmary for Nervous Diseases: Case histories; ca. 1872 ca. 1 942., (#000108031). Vol. 16, p. 119.

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223 Single men talked about their sexual experiences also. A restaurant worker declared at including sodomy. 80 A tinsmith named Joseph Bruner stated he had sex with 50 women (though the record indicated he denied syphilis, the underlined word highlighting the disbelief that a man who declared such prowess remained clear of the disease). 81 S.S. Craig, discussed earlier, talked about his tendency to overthink sexual matter s, a practice which fueled his desire to the point where, by his own estimation, it became excessive and difficult to control. 82 Benjamin Harbach, a married working some prostitute he 83 D r. Beard counseled a scientist who planned to marry a young woman with whom stlessness and eye irritation descended upon him. The patient wanted to know if the orgasm produced by dalliances would affect his health. While a pr evious physician Beard described told the patient marriage would provide a cure, Beard prescribed strengthenin before marrying. 80 Philadelphia Orthopaedic Hospital and Infirmary for Nervous Diseases: Case histories; ca. 1872 ca. 1942, (#000108031). Vol. 15, p. 191. 81 The record may say 80 the first digit is a bit difficult to discern. To av oid risking exaggeration, I am going with 50. Philadelphia Orthopaedic Hospital and Infirmary for Nervous Diseases. : Case histories; ca. 1872 ca. 1942, (#000108031). Vol 15, p. 258. 82 Ibid., 276. 83 Philadelphia Orthopaedic Hospital and Infirmar y for Nervous Diseases: Case histories; ca. 1872 ca. 1942, (#000108031). Vol. 16, p. 112.

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224 amounts of sex until his nervous system toned up. The patient took only half the medical advice: he married right after his visit. Weeks later, the man returned to Dr. Beard, distraught, reporting After a mere week of coitus, the patient could not bear the suffering and was finally willing to follow the tonic treatment Beard recommended strength returned. 84 conjure moral condem nation upon the patient. In fact, the neutrality with which he wrote about orgasmic dalliances indicated he found no medical reason to avoid them. That they caused the patient trouble seemed to be the only motive for restraint. Implicitly, Beard condoned orgasmic dalliances as long as a person was up for them. By publishing this case study, he amplified his normalization of pre or non marital sex, and modeled ways other physicians should handle their The most powerfully illustrative case of the ways in which the clinical interactions between doctor and patient served to normalize a variety of sexual acts was forty year old Stephen Ryan. His sexual history monopolized his intake more than most. He reported bou ts of or 4 times a month. Practices titillation with figure to induce erection at the time. History of unclear whether his sexual activity occurred within marriage. However, the most compelling Ryan. He dismissed the patient from the clinic, and, by implication, encouraged him to continue 84 Beard, Sexual Neurasthenia, 187 8.

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225 as before. He needed no vacation or sedatives, no remedy or treatment for his behavior. This case illustrates the ways doctors conferred tacit approval upon patients. In the case of Ryan, the lack of proscription showed the patient did not warrant any form of rehabilitation. d 85 The function of the penis, or its potential malfunction, compelled men to tell the doctor all about it. In one particularly detailed account from Edward S mith, a married man of 14 health conditions and abstained from liq uor and tobacco. His sole concern was that his genitals did not function properly doctor. 86 A single working think abou their physical conditions and expected the doctor to frame them in terms of nervous illness. This is significant, because as I have shown in this dissertation, nervous dis eases affected the body but did not reflect any kind of fundamental or permanent problem with the body. As part of nervous illness, erectile troubles or discharge became bound up in the rhetoric of neurasthenia, thereby odies were constitutionally weak or inferior. By bringing genital concerns to the doctors treating nervous illnesses, patients and doctors discussed these 85 Philadelphia Orthopaedic Hospital and Infirmary for Nervous Diseases: Case histories; ca. 1872 ca. 1942, (#000108031). Vol 15, p. 291. 86 Ibid., 365.

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226 symptoms through the lens of neurasthenia rhetoric, rendering their conditions impermanent, not s own fault, and treatable. By describing these physical ailments within the context of the Infirmary for Nervous Diseases, doctors and patients translated genital dysfunction into a fleeting nervous disease, for which a patient could not be blamed. In any case where previous masturbation or sexual excess could be at fault, the framework of neurasthenia removed culpability from the patient. In other Docto In the clinic, diagnosis and treatment of emotional and sexual problems involved three tenets: emotional sympathy, sexual normalization, and listening. George Beard promoted these strategies in his book Sexual Neurasthenia and exercised them in his clinic. The power and case histories involving other physicians. physicians outside me dical epicenters like New York, Chicago, and Philadelphia generally shared similar understandings of neurasthenia. 87 And yet physicians failed to reckon with their own sexual and emotional problems; like ordinary people, they needed the definitive diagnos is from a physician. Unable to treat themselves, p dysfunction and anxieties One young physician who had been married for a year told Beard he tried having sex with his bride three times; all of them resulted in premature emissions -which 87 F.G Gosling, Before Freud: Neurasthenia and the American Medical Community, 1870 1910. (Urbana, IL: University of Illinois Press, 1987).

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227 judged to be 2 3 times a week), was constitutionally strong, and was generally in good form. Beard applied local health: reproduction! This case highlights the importance of the process of talking with a doctor. Even for a physician, to whom all medical information would have been available, self Due to the roper course of treatment figured centrally in its success. For some men, marriage stood as a desirable outcome of recovery, and provided evidence of the successful treatment of sexual trouble in Sexual N eurasthenia ended in marriage. A thirty seven year have occasional sex with women. He came to Dr. Beard to address the fact that none o f these e too soon, and intercourse was ight testicle and elongated foreskin. Because his overall health was strong --he felt no pains, maintained a sharp memory, and had good digestive functions -Beard treated this case locally. 88 He administered mineral acids, ergot alkaloids to improve circ ulation 89 and belladonna, which was considered a prophylactic antibiotic by 19 th century physicians. 90 He gave the patient localized electric therapy using hot 88 Beard, Sexual Neurasthenia, 176 7. 89 Joseph R. Buchanan and R. S. Newton, The Eclecti c Medical Journal, Series 3, Vol. 3, (Cincinnati, OH: George H Lawyer, Printer, 1854), 398. Ergot treatments were often given to women for issues related to reproductive health. 90 Ibid., 543.

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228 and cold catheters a therapy Beard promoted for many health issues. Beard encouraged the patient 91 this could be properly channeled into a reproductive marital pair. By no means did marriage a ct as a panacea for iseases Beard was clear 92 Yet it was clear marriage represented a source of responsibility and manly gender role performance that many men rejected To report to the doctor that treatment facilitated successful marital union, or even a pregnancy, indicated a man had overcome his nervous prostration at symbolically. The elixirs offered in the Infirmary for Nervous Diseases reflected widely accepte d treatments for neurasthenia at the time: doctors commonly proscribed sedatives like potassium bromide and strychnine; some advised patients to go outside, rest, and abstain from coffee, hment, 93 a few proscribed marijuana. 94 Some cases warranted carefully crafted elixirs, such as a mixture of ferri quinine and strychnine, which combined iron therapies with sedative. There appears to be no discernable 91 Beard, Sexual Neurasthenia, 177. 92 Ibid., 198. 93 "T he Be st Preparations of Iron ." Medical Record (1866 1922) 44, no. 2 (Jul 08, 1893): 1. 94 confidently read, my findings are consistent with other scholarsh ip on treatment for neurasthenia.

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229 trend that connects treatments to the specific conditions of the patient. Treatments varied widely, and as popular medical literature explained, no two cases of nervous illness were alike. Therefore, it is likely that neither doctor nor patient sought consistency, but instead, they considere d each clinical interaction to be a singular form of treatment. well being mattered significantly. Dr. Mitchel and his colleagues at the Philadelphia Infirmary p hysicians knew this well. In his 1903 manuscript, Rest, Mental Therapeutics, Suggestion, Dr. Francis X. Dercum one of the physicians who worked at the Philadelphia Infirmary for Nervous Disease in the early 1890s confirmed the significance of the suggesti on on the course of disease, while not infrequently exaggerated in general literature and in pseudo scientific writings, is real, and must be recognized by phys 95 In fact, the purpose of the book was to educate physicians on their power to influence the mental state of a patient, and to use that power productively. Dercum noted that patients already succumbed to a broader pool of suggestions outside the clinic a point that chapters three and four of this dissertation confirm. Inside the clinic, however, suggestion served as a powerful complement to treatments of the physical body. 96 Physicians needed to use it carefully, and well. The patients at the Philadelphia Infirmary for Nervous Diseases needed subtle affirmation from a doctor to restore confidence in the healing power. Many battled emotional conditions which convinced them they had potentially destroyed their own health Dercum argued that sug 95 Francis X. Dercum, Rest, Mental Therapeutics, Suggestion (P. Blakiston's son & co, Philadelphia, 1903): vi. 96 Ibid., 250.

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230 treatment, or offering a routine treatment directed a patient toward his recovery and generated avoiding triggering any mental images that c ould alarm the patient and resists overstatement of suggestion sufficed. Simply treating the disease provided affirmation of its existence and a hopeful route to a cure. 97 and consequence of the sexual debility they experienced. To allow the worry to go unchecked would perpetuate and multiply the neurasthenic symptoms. Placebo tests showed patients who real were promised. 98 Beard was surpr but maintained the improved condition some recovered entirely. As a result of this study, he pati ent; he called this strategy mental therapeutics. This was especially important because too patients suffered distressing numbers of nocturnal emissions sometimes seve ral times each night. The young man fell in love and went to doctors to find relief from this habit before he 97 Ibid., 253 4. 98 Beard, Sexual Neurasthenia, 90.

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231 the importance of recognizing to do otherwise only propelled men further into a nervous state. Mitchell encountered sexually distraught men with considerable sympathy as well, but described it using a religious fram ework. Patients arrived in his hospital worked up with anxiety over their health and sexual performance. Rather than provide a moral condemnation, Mitchell phy sician are oftener told the long, sad tales of a whole life, its far away mistakes, its failures, 99 The clinic offered men private space and a sympathetic, professional ear to unload the shadows of past indiscretions. In a moment when scientific information about manhood, bodies, race, and sexuality constantly refashioned definitions of health and morality, men struggled to hold onto any single paradigm. Furthermore, they existed amidst shifts in sexual mores, away from an era which co ndemned masturbation as physically harmful and morally reprehensible. Soon, Freud would argue that masturbation occurred naturally and should not be viewed with disdain. Men in the 1880s and 1890s stood at the crux of this shift, beginning to see glimpse s of the coming paradigm shift that included sexual desire and orgasm as part of healthy sexual life. But, as the records show, the threats that masturbation ruined future sexual satisfaction loomed heavily on men. They required the gentle affirmation of a physician to abdicate their feelings of guilt, shame, or fear. The most important treatment offered by physicians of nervous diseases was the histories into o fficial hospital ledgers, and declaring men the temporary sufferers of nervous 99 Mitchell, Doctor and Patient, 10.

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232 disease, doctors gave men the professionally sanctioned framework of neurasthenia with which to interpret their lives, choices, and circumstances. While many men attempted to u se this framework themselves demonstrated by the vast knowledge they had about the subject of neurasthenia and sexual health it proved insufficient to quell the haunting fears they had gotten it all wrong. By disclosing inadmissible truths about themselve s to a famous, yet sympathetic physician, patients shared the burden of responsibility to interpret and assess the symptoms. as functions of temporary disease a disease borne out of broader urban, industrial, and modern society, and of no fault of their own. This reinterpretation allowed a worried, fearful, sexually excessive man to reenvision himself as a neurasthenic. 100 A short visit to the clinic provided a flashpoint for this interpretation: exiting the hospital as a neurasthenic, a man could leave his past indiscretions behind and move forward, unburdened. Most patients visited the clinic only once. Given the months or years they suffered prior to finall y deciding to seek medical care, it seems as though patients took their clinic visit seriously. For some, it cost money; for others, it involved out of town travel. For all, it meant exposing deeply held shame about intimate sexual and emotional struggle s. As I have argued in this chapter, men approached the clinic with a vocabulary about neurasthenia and a set of expectations about what doctors of nervous disease offered. They knew what they wanted, and they went to the doctor to get it. Because the m ost significant part of treatment for neurasthenia occurred in the interaction between doctor and patient, and the medical absolution they received from their doctors, most men found one session to be enough. They left with a clear sense that 100 Neurast henic, or using whatever diagnostic term they chose. They were mostly interchangeable, especially sexual neurasthenia and general neurasthenia.

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233 their sexual habits and emotional struggles had passed before the careful scrutiny of a doctor in this case, the most renown doctors of nervous diseases in the country and left with some mild medicines (sedatives, pain relievers, or vitamins, most likely). Nothing ab out the interaction had alarmed the doctor. Looking at the aggregate of the patient data, it is clear how doctors heard similar stories from men, year after year. While a patient may not have known specifics about their experiences were common normal, even. Most importantly, the symptoms did not indicate grave constitutional inadequacy: rather, men came into the clinic worried their health was in peril, and left with confidence they could separate themselves from an unhealthy past and confessor can be interpreted to include the clinic as a confessional. While most tr eatments succeeded, not every man overcame his nervous illness through clinical treatment. As Dercum, Beard, and Mitchell argued, effective therapies required participation from the patient. They needed to believe in, respond to, and follow the proscript ion in order for it to work. This is not to suggest the treatment plans relied wholly on the placebo effect Rather, as the clinical visit itself served as the crucial site of negotiation between doctor and patient both parties needed to participate in t he cure. Some men failed to invest the effort into their own treatment and continued suffering their condition. The case of Gilbert Rooms indicates the ways in which doctors expected patients to be agents of their own recovery. A twenty year old butche r, he came to the Infirmary for Nervous

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234 estimated his overall health 101 The doctor proscribed him antipyrin, commonly used a pain reliever and fever reducer. 102 adjusted his proscription, this time sending him home with an elixir of hydrombromic acid 103 and potassium bromide, a sedative. This reduced his emissions. He returned two months later and received a new pr e scription. But another two months passed, and the doctor declared Rooms ve the main line of text, as if it was important to cast responsibility onto the patient for failing to recover. This is the only indication in the data set that blames a patient for his condition. By contrast, then, the lack of remonstrance in almost al l of the records affirmed the doctors did not cast judgment on their patients. With the exception of Gilbert Rooms, doctors offered approval and support for their if treatment failed would a patient be blamed. Doctors consciously participated in this process of medical absolution. In fact, as chapter two demonstrated, S. Weir Mitchell thought of himself as a confessor to his patients. He considered his services b 104 Mitchell characterized the doctor patient interaction as a comforting space that g, sad tales 101 Philadelphia Orthopaedic Hospital and Infirmary for Nervous Diseases: Case histories; ca. 1872 ca. 1942., (#000108031). Vol. 15, p. 365. 102 Sir William Osler, The Principles and Practice of Medicine, Designed for the use of Practitioners and Students of Medicine (United States, 1920): 60, 125, 352. 103 Samuel Otway Lewis Potter. Handbook of Materia Medica, Ph armacy, and Therapeutics, (Philadelphia: B Plakinston, Son & Co., 1893): 738 104 Mitchell, Doctor and Patient, 43.

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235 of a whole life, its far 105 As a confessor, physicians leveraged medical expertise in place of divine intervention. A faithful patient dutifully internalized the rhetoric of neurasthenia: what previ ously paralyzed men with fear they had permanently ruined their health, transformed into optimism. The framework of neurasthenia removed blame from an individual man for vice, sexual excess, failure to go to work and placed it onto industrial society. To gether, the doctor and the patient morally neutralized the history of sexual indiscretion, and offered men a new chance to return to happy, productive, and healthy lives. 105 Mitchell, Doctor and Patient, 10.

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236 CHAPTER 7 C ONCLUSIONS Neurasthenia, its rhetoric and its popularity, changed shape after the turn of the century. Historians disagree about when the diagnosis fell out of favor in the United States. Within the context of the YMCA, John Donald Gustav Wrathall argued the YMCA began to formalize its sex education curriculu m by 1899. 1 In 1918, the YMCA joined efforts with the U.S. Public Health Service to deliver sex education to young men. Rooted in the their sexual purity would inoculate them from debility related to sex (such as syphilis). Alexandra M. Lord argues this paradigm much like neurasthenia did in the 1880s and 1890s -l war world. 2 Unlike neurasthenia rhetoric, which absolved men of their indiscretions and resulting poor health, the post war curricula blamed men who failed to keep physically and morally fit. This marked a notable shift from l ate nineteenth century model 3 Scholars identify three important ways World War I reframed neurasthenia. First, WWI brought syphilis and illicit sex -into full view as a public health issue. 4 In response, city 1 John Donald Gustav Wrathall. Take the Young Stranger by the Hand: Same Sex Relations and the YMCA (Chica go: University of Chicago, 1998): 37 2 YMCA, 1919 1924. Journal of the History of Medicine and Allied Sciences 58 no. 2 (2003): 136. 3 Ibid., 143. 4 The syphilis epidemic during and after World War I is widely understood by historians. For information on the American context see: E.H. Beardsley "Allied Against Sin: American and British Responses to Venereal Disease in World War I." Medical History 20 no. 2 (1976) 189 202; Toni P Miles and David McBride, "World War I Origins of the Syphilis Epidemic among 20th Century Black Americans: A Biohistorical Analysis." Social Science & Medicine 45 no. 1 (1997): 61 69; John Parascandola, Sex, Sin, and Science: A History of Syphilis in America

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237 legislators mobilized public health services, trained hygienists, and funded programs aimed to clean up the sexual fil th endemic to urban life. Second, the barbarity of modern warfare devastated the psyches of soldiers. On the front lines, soldiers experienced nervous breakdowns similar The Great War and Modern Memory argues that the trenches created a panicked intimacy among men who served together. Fussell says though when sex between men occurred men perceived it as something from which they youthfulness 5 For these reasons, Rebecca Hyman argued that after the war, neurastheni 6 Julian Carter argues neurasthenia survived World War I and doctors continued to use it into the 1920s as a way to describe the root of marital conflicts. Brad Campbell claims that neurasthenia enjoyed an important place among medical communities and the public in the first third of the twentieth century. He contends the legacy of neurasthenia the neurotic American subject -it continued to perform substantial cultural work into the 1930s. 7 Historians also consider the impac t of Freudian psychoanalysis when determining the end of neurasthenia. As Freud offered new ways to interpret the self and, as Tom Lutz put it, to (Westport, Conn: Praeger, 2008): Chapter 3; For European accounts, see Ruth Harris, "The "Child of the Barbarian": Rape, Race and Nationalism in France during the First World War." Past and Present 141, (1993) 170 206. 5 Fussell, The Great War and Modern Memory (Oxford University Press, New York, 1977) : 272 274. 6 Rebecca Hyman, Territories of the Self: Nervous Disease and the Social Logic of Pre Freudian Subjectivity Unpublished dissertation, University of Virginia, 199 8, 9. 7 History of Psychiatry 18, (2): 159.

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238 neurasthenia declined. 8 In its place, Freudian introduced concepts of the unconscious, the libido, and the naturalness of masturbation. These began to influence American psychiatry by 1915, and neurasthenia transformed. 9 History of Psychiatry posit s that Freud and his diagnosing their mental illness. 10 Shorter views the primary contribution of psychoanalysis is that it drew treatment of mental illness out of the asylum and into private offices. 11 As this dissertation shows neurologists in the 1880s and 1890s routinely heard the life stories of patients, and fielded a patchwork of emotional, mental, and physical symptoms. The private space of the office (or, with one another) comforted men and facilitated trust. This work contributes to the knowledge Th e twentieth century professional categorizations of neurasthenia varied. In fact, historian of neurasthenia in China, Liu Shixie, describes the medical attitude toward the disease th e American Psychiatric Association recognized neurasthenia, and in 1942 the American Medical Association followed suit. However, the first volume of Diagnostic and Statistical Manual of Mental Disorders, or DSM I published in 1952, excluded the diagnosis The next volume, published in 1968, 8 Tom Lutz, American Nervousness, 1903: An Anecdotal History (Ithaca, NY: Cornell University Press, 1991): 285. 9 Eliza beth Lunbeck, The Psychiatric Persuasion: Knowledge, Gender, and Power in Modern America. Princeton, NJ: Princeton University Press, 1994): 22 26. 10 Shorter, Edward, A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. (New York: J ohn Wiley & Sons, Inc., 1997): 100. 11 Ibid., 145 160.

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239 reintroduced neurasthenia. T he DSM III in 1980 left it out, and it has remained absent from subsequent volumes. 12 Some scholars see the legacy of neurasthenia turning up in recent medical history. Susan Abbey and Pau l Garfunkel link nineteenth century instances of neurasthenia with contemporary diagnoses of chronic fatigue syndrome. 13 Similarly opaque and possessing a variety of symptoms and etiologies, chronic fatigue syndrome performs similar cultural work in recent decades that neurasthenia did in the Gilded Age. Joseph Conner traces the legacy of war trauma, War, to battle fatigue and PTSD during and after World War I I. 14 Interestingly, rapid industrialization in China caused a revival of the old fashioned term. In Chinese clinics, neurasthenia or shenjing shuairuo, experienced a resurgence in use in the 1980s and 1990s. 15 Chinese neurasthenics reported stress three different types: work related, school related, and personal as the three main causes of their disease. 16 Some reports indicated intrinsic personality traits made a person more inclined to suffer neurasthenia. Regardless, the symptoms resembled those Beard explained: headache, fatigue, and pain. Essentially, Chinese 12 Culture, Medicine, and Psychiatry 13 no. 2 (June 1989): 164. 13 enia and Chronic Fatigue Syndrome: The Role of Culture in the American Journal of Psychiatry, (vol 142, issue 12, 1991): 1638 46. 14 Joseph Connor, World War II 31, Weider History Group, Inc, Leesburg, 2017. 15 Arthur Kleinman, Social Origins of Distress and Disease: Depression, Neurasthenia, and Pain in Modern China (New Haven, Conn: Yale University Press, 1986); Sing Lee, and Arthur Kleinman. "Are Somatoform Disorders Changing with Time? The Case of Neurasthe nia in China." PSYCHOSOMATIC MEDICINE 69 no. 9 (2007): 846 849; QIN, YH. "Neurasthenia in China." PSYCHIATRIC ANNALS 22, no. 4, (1992) 188 189. Wen Ji Wang, "Neurasthenia and the Rise of Psy Disciplines in Republican China." East Asian Science, Technolog y and Society 10, no. 2 (2016): 141. 16 Culture, Medicine, and Psychiatry 13 no. 2 (June 1989): 175

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240 psychiatrists incorporated the Western concept into their medical practices, and in doing so, 17 N onetheless, it provided a useful framework for doctors and patients to negotiate the psychic impact of rapid industrialization in China. Clearly, neurasthenia does not have a clear beginning or clear endpoint, if any at all. What matters for this disserta tion is how the diagnostic category in the Gilded Age provided a language for challenging questions about manly self identity, power, and physicality for many white men. And its flexibility accommodated different kinds of men to help them address morally fraught concerns about sexual behavior and health using (relatively) neutral medical terminology. However, as this dissertation shows, medical language no longer appears neutral when viewed as a cultural agent rather than strictly an objective medical term The methodological and theoretical underpinnings of this dissertation present some opportunities for future historical research. One notable question left unanswered is: was neurasthenia rhetoric present in black newspapers, black and native YMCA branch es, and in clinics non whites visited? The findings of this dissertation would benefit from this kind of comparison. Another direction this work points to is a longitudinal history of medical diagnoses that similarly help white men reconcile white suprem acy and patriarchy with their own experiences of weakness or failure. In unique political moment in which I write this dissertation, These men report feeling al ienated and excluded by affirmative action practices, and they denounce the progressive ideologies that produce them. I wonder how (if?) they are talking to counselors and doctors about their emotional and psychological trauma. They certainly are 17 Ibid., 182.

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241 talking about it on the internet, which seems to incubate a community of support for similarly afflicted men. Perhaps neurasthenics of the 1890s and the men of the alt right have striking similarities and rely on the technologies of their era to engage in an ana logous process of disclosure and mutual validation. Future research on how information technologies and medical knowledge work together since the Gilded Age might provide a fascinating window into ways white men simultaneously benefit from and are damaged by the intersection of white supremacy and patriarchy. about healthy sexuality. The ubiquity of sexual content on the internet attracts moral and medical questio men wonder: am I normal? Is this healthy? I first made the connection between this research on neurasthenia in the Gilded Age and contemporary interventions in sexual healt h when my students started to write papers about it. I teach a college writing course, and students may choose their own topic for a paper in which they wrestle with an unsolved problem. To my surprise, several students (all men) elected to write about ho w porn negatively affected young erectile dysfunction and unhealthy expectations for sex with other people, these young men brought in the popular sources that shape d their view: and WebMD ranked highest. It turns out that the twenty first century equivalent of the Police Gazette ( or websites like and Wear and Tear ( WebMD ) inundated men with intimidating warnings that unhea lthy masturbation habits could have perilous effects on their health. For dysfunction. Underneath an intimidating limp a

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242 study that concluded 25% of young men suffer from ED, and the rate is up from 2% just 12 years prior. 18 its in their 20s with a greater likelihood they will develop early prostate cancer. 19 Finally, a psychologist testifies on and harder and more graphic porn you need in order to get it up. I f the trend continues, men can find themselves physically unable to maintain an erection, much less enjoy sexual contact with another 20 Like their nineteenth century counterparts, these sources harness the visibility of the media to excite fears a Perhaps neurasthenia has changed names, and perhaps WebMD does not solicit the support of religious leaders to ingratiate itself with its audience. But, the legacy of neurasthenia, as Brad Campbell p uts it, remains today. This dissertation answers questions about the value of sense of themselves as gendered, racialized, and healthy Americans. 18 La st updated March 3, 2014. women/porn erectile dysfunction 19 WebMD. Last updated Jan uary 27, 2009. cancer/news/20090127/masturbation and prostate cancer risk#1 20 Accessed February 17, 2017. fitness/health/are you wa tching too much porn 20130821

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243 L IST OF REFERENCES Primary Sources Newspapers and Periodicals The Ladies' Home Journal Journal of Nervous and Mental Disease Journal of the American Medical Association Medical and Surgical Reporter New York Times Philadelphia Inquirer Police Gazette Phrenolog ical Journal and Science of Health Washington Post Archives Cass County Divorce Records, North Dakota State University Library George Beard Papers Yale University Archives Kautz Family YMCA Archiv es, Un iversity of Minnesota Libraries Philadelphia Orthopaedic Hospital and Infirmary for Nervous Diseases, College of Physicians, Philadpelphia, PA Silas Weir Mitchell Papers College of Physicians, Philadelphia, PA YMCA Pamphlet Collection, Un iversity o f Minnesota Libraries

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244 Secondary Sources A bbey S E and P E G arfunkel "Neurasthenia and Chronic Fatigue Syndrome: The Role of Culture in the Making of a Diagnosis." American Journal of Psychiatry 148.12 (1991): 1638 46. Web. Allen, Theodore The Inven tion of the White Race London ; New York: Verso, 1994. Arnett, Jeffrey Jensen. "G. STANLEY HALL'S ADOLESCENCE: Brilliance and Nonsense." History of Psychology 9.3 (2006): 186 97. Bakker, Nelleke. "Before Ritalin: Children and Neurasthenia in the Netherl ands." Paedagogica Historica 46.3 (2010): 383 401. Beam, Alex. Gracefully Insane : The Rise and Fall of America's Premier Mental Hospital / Alex Beam 1st ed. ed. New York: Public Affairs, 2001. Beard, George M. American Nervousness its Causes and Conseq uences, a Supplement to Nervous Exhaustion (Neurasthenia) S.l: New York : Putnam, 1881. --. Sexual Neurasthenia (Nervous Exhaustion) its Hygiene, Causes, Symptoms, and Treatment, with a Chapter on Diet for the Nervous New York: Arno Press, 1972. Bear dsley, E. H. "Allied Against Sin: American and British Responses to Venereal Disease in World War I." Medical history 20.2 (1976): 189 202. Bland, Lucy, and Laura L. Doan. Sexology in Culture : Labelling Bodies and Desires Chicago: The University of Chic ago Press, 1998. Briggs, Isaac G. Epilepsy, Hysteria, and Neurasthenia, their Causes, Symptoms & Treatment England; United Kingdom:, 1921. Briggs, Laura. "The Race of Hysteria: "Overcivilization" and the "Savage" Woman in Late Nineteenth Century Obstetr ics and Gynecology." American Quarterly 52.2 (2000): 246 73. Burbick, Joan. Healing the Republic : The Language of Health and the Culture of Nationalism in Nineteenth Century America Cambridge England : Cambridge University Press, 1994. Burr, Charles W. S. Weir Mitchell, Physician, Man of Science, Man of Letters, Man of Affairs Philadelphia: The College of Physicians, 1920. California University University at Los Angeles Dept of,Medical History, et al. The History of Medical Education; an International Symposium Held February 5 9, 1968 Berkeley: University of California Press, 1970.

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245 Campbell, Brad. "The Making of `American': Race and Nation in Neurasthenic Discourse." History of Psychiatry 18.2 (2007): 157 78. Cervetti, Nancy. S. Weir Mitchell, 1829 1914 Philadelphia's Literary Physician University Park, Pa: Pennsylvania State University Press, 2012. Chapman, David L. Sandow the Magnificent : Eugen Sandow and the Beginnings of Bodybuilding Urbana: University of Illinois Press, 2006. Chauncey, Geor ge, and Queer Literature Collection. Gay New York: Gender, Urban Culture, and the Making of the Gay Male World, 1890 1940 New York: Basic Books, 1994; 2008. Chudacoff, Howard P. The Age of the Bachelor : Creating an American Subculture Princeton, N.J: P rinceton University Press, 1999. Church, Archibald b. 1861, and Frederick Peterson. Nervous and Mental Diseases 6th ed. thoroughly rev. ed. Philadelphia: Saunders, 1908. Connell, Raewyn. Masculinities Berkeley: University of California Press, 1995. Co nnor, Joseph. Let there be Light 31 Vol. Leesburg: Weider History Group, Inc, 2017. Dana, Charles Loomis. Text Book of Nervous Diseases and Psychiatry, for the use of Students and Practitioners of Medicine 6 th ed. ed. New York: W. Wood and company 1904 Davis, Allen Freeman, et al. The Peoples of Philadelphia; : A History of Ethnic Groups and Lower Class Life, 1790 1940 Philadelphia: Temple University Press, 1973. Degler, Carl N. "What Ought to be and what was: Women's Sexuality in the Nineteenth Cent ury." The American Historical Review 79.5 (1974): 1467 90. Dercum, Francis X. (Francis Xavier). A Text Book on Nervous Diseases by American Authors Philadelphia: Lea Brothers 1895. Devine, Shauna. Learning from the Wounded: The Civil War and the Rise o f American Medical Science First ed. Chapel Hill: The University of North Carolina Press, 2014. Ducat, Stephen. The Wimp Factor : Gender Gaps, Holy Wars, and the Politics of Anxious Masculinity Boston: Beacon Press, 2004. Earnest, Ernest Penney. S. Wei r Mitchell, Novelist and Physician Philadelphia: University of Pennsylvania Press, 1950. Fee, Elizabeth. Disease and Discovery: A History of the Johns Hopkins School of Hygiene and Public Health, 1916 1939 Baltimore: Johns Hopkins University Press, 1987

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246 Fischer, Suzanne Michelle. "Diseases of Men: Sexual Health and Medical Expertise in Advertising Medical Institutes, 1900 1930." ProQuest Dissertations Publishing, 2009. Foote, Edward B. (Edward Bliss). Sexual Physiology for the Young New York: Murray Hill Publishing Co., 1887. Freeman, Susan Kathleen. Sex Goes to School: Girls and Sex Education before the 1960s Chicago: University of Illinois Press, 2008. Friedman, David M. 1949 A Mind of its Own : A Cultural History of the Penis / David M. Friedman New York: Free Press, 2001. Furst, Lilian R. Before Freud : Hysteria and Hypnosis in Later Nineteenth Century Psychiatric Cases Lewisburg: Bucknell University Press, 2008. Fussell, Paul. The Great War and Modern Memory New York: Oxford University Pre ss, 1975. Gamwell, Lynn, and Nancy Tomes. Madness in America : Cultural and Medical Perceptions of Mental Illness before 1914 Ithaca, N.Y. : Binghamton, N.Y: Cornell University Press ; Binghamton University Art Museum, 1995. Gelfand, Toby, and John Ker r. Freud and the History of Psychoanalysis Hillsdale, NJ: Analytic Press, 1992. Gijswijt Hofstra, Marijke, and Roy Porter. Cultures of Neurasthenia from Beard to the First World War Amsterdam : New York: Rodopi, 2001. Gilman, Charlotte Perkins, and Zon a Gale. The Living of Charlotte Perkins Gilman, an Autobiography New York: Lonodn, D. Appleton Century company, 1935. Century Russia." Medical history 47.1 (2003): 2 3 46. Goodrum, Charles A., and Helen Dalrymple. Advertising in America: The First Two Hundred Years New York: Harry N. Abrams, 1990. Gorn, Elliott J. "The Wicked World: The National Police Gazette and Gilded Age America." Media Studies Journal 6.1 (1992 ): xviii. Gosling, Francis G. Before Freud : Neurasthenia and the American Medical Community, 1870 1910 Urbana: University of Illinois Press, 1987. Gould, George M. The Jefferson Medical College of Philadelphia : Benefactors, Alumni, Hospital, etc., its Founders, Officers, Instructors, 1826 1904 : A History ., 1904. Gowers, W. R. A Manual of Diseases of the Nervous System Philadelphia: Blakiston 1888.

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247 Graham, Douglas. Manual Therapeutics, a Treatise on Massage, its History, Mode of Application and Effe cts, Indications and Contra Indications 1902. Grob, Gerald N. The Mad among Us : A History of the Care of America's Mentally Ill New York : Toronto : New York: Free Press ; Maxwell Macmillan Canada ; Maxwell Macmillan International, 1994. --. Mental Il lness and American Society, 1875 1940 Princeton, N.J: Princeton University Press, 1983.. Gross, Samuel W. A Practical Treatise on Impotence, Sterility, and Allied Disorders of the Male Sexual Organs Philadelphia: H. C. Lea's S on & Co., 1881. Guiteras, Ramon "Sexual Neurasthenia in the Male; a Plea for a More Accurate use of the Term; Treatment of the True Form with Citation of Cases." Medical News (1882 1905) 79.2 (1901): 52. American Periodicals. Web. Hall, G. S. Adolescence; its Psychology and its R elations to Physiology, Anthropology, Sociology, Sex, Crime, Religion and Education, by G. Stanley Hall .. New York: D. Appleton and Company, 1904. --. Life and Confessions of a Psychologist, by G. Stanley Hall .. New York: D. Appleton and company, 1923. Haller, John S. and Robin M. Haller. The Physician and Sexuality in Victorian America Urbana: University of Illinois Press, 1974. Hammond, William A. (William Alexander). A Treatise on the Diseases of the Nervous System 9th ed. : with corrections and additions. ed. New York: Appleton, 1891. Harris, Ruth. "The "Child of the Barbarian": Rape, Race and Nationalism in France during the First World War." Past & Present .141 (1993): 170. Hayden, Deborah. Pox: Genius, Madness, and the Mysteries of Syphilis New York: Basic Books, 2003. --. Pox: Genius, Madness, and the Mysteries of Syphilis New York: Basic Books, 2003. Haynes, April R., and Ebooks Corporation. Riotous Flesh: Women, Physiology, and the Solitary Vice in Nineteenth Century America Chicago; London: University of Chicago Press, 2015. The Herriges Horror in Philadelphia : A Full History of the Whole Affair. A Man Kept in a Dark Cage Like a Wild Beast for Twenty Years, as Alleged, in His Own Mother's and Brother's House: .. Philadelphia: C.W. A lexander University of Florida Library Catalog; Mango Discovery;

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248 Hinsdale, Guy. S. Weir Mitchell .. Philadelphi a: J. B. Lippincott co University of Florida Library Catalog; Mango Discovery; Hoganson, Kristin L. Fighting fo r American Manhood: How Gender Politics Provoked the Spanish American and Philippine American Wars New Haven, Conn: Yale University Press, 1998. Hlscher, Johannes,Gerardus Aldegondus, and Hogeschool Eindhoven Technische. The Influence of Positive Space Charge on the Position and the Movement of Holst and Oosterhuis Light Layers Eindhoven: Technische Hogeschool, 1964. Horowitz, Helen Lefkowitz. Rereading Sex : Battles Over Sexual Knowledge and Suppression in Nineteenth Century America New York: Alfred A. Knopf, 2002. Humphreys, Margaret. Marrow of Tragedy : The Health Crisis of the American Civil War Baltimore: The Johns Hopkins University Press, 2013. Hyman, Rebecca Charlotte. "Territories of the Self: Nervous Disease and the Social Logic of Pre Fr eudian Subjectivity." 1999. Jacobson, Matthew Frye. Barbarian Virtues: The United States Encounters Foreign Peoples at Home and Abroad, 1876 1917 1st ed. New York: Hill and Wang, 2000. James, Henry and F. W. Dupee. Henry James, Autobiography / Edited wi th an Introduction by Frederick W. Dupee Princeton, N.J: Princeton University Press, 1983. Kahn, Robert Johnstone. Man's Mission on Earth; a Contribution to the Science of Eugenics. A Short Treatise on the Genito Urinary Organs of the Male in Health and Disease, with a Chapter on Syphilis 49th ed., New York: I. Goldmann Co ., 1917. Kasson, John F. Houdini, Tarzan, and the Perfect Man: The White Male Body and the Challenge of Modernity in America 1st ed. New York: Hill and Wang, 2001. Katz, Jonathan. The Invention of Heterosexuality University of Chicago Press ed. ed. Chicago: University of Chicago Press, 2007. Kelly, Lori Duin. "Selecting a Somatic Type: The Role of Anorexia in the Rest Cure." The Journal of medical humanities 33.1 (2012): 15 26. Keye s, E. L.,Jr. "The Need of Sexual Education." Medical News (1882 1905) 86.25 (1905): 1165. American Periodicals. Killen, Andreas. Berlin Electropolis : Shock, Nerves, and German Modernity Berkeley: University of California Press, 2006. University of Flori da Library Catalog; Mango Discovery; Web.

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254 BIO GRAPHICAL SKETCH Mallory Renee Szymanski was born in Parma, Ohio. She grew up outside Clevela nd and moved to the Tampa Bay area as an adolescent. In 2006, Mallory graduated from the University of Florida with a Bachelor s of Arts of Arts in history by the University of Florida in 2017.