The Nineteenth Century: When Many Remedies were Lethal by M. Louisa Locke

When I started doing the research for Lethal Remedies, the seventh book in my Victorian San Francisco mystery series, all I knew was that I wanted this book to feature women in the medical professions in San Francisco (the books in this series each look at different occupations by women in the late nineteenth century.)

Little did I know in October 2019 when I chose the title or in the beginning of March when I put the finished book up for pre-order how relevant both the title and the subject of the book would become as the Covid-19 disease began to ravage our world.

My mysteries are cozies—designed to entertain as well as enlighten readers about the past––and I am afraid a mystery about people dying in an epidemic wouldn’t have been quite the uplifting experience I want for my readers right now, so I am glad that I didn’t make an epidemic the cornerstone of my mystery.

Not being prescient, that decision was based entirely on my desire for historical accuracy. I’d discovered that in the spring of 1882, when the book was set, San Francisco wasn’t going through one of its periodic epidemics of cholera, small pox, or the plague, so I had passed that by as a possible plot point.

However, what I did discover during my research was that in the last half of the nineteenth century, modern medicine was still very much in its infancy. As a result, the experimentation and commercialization that was going on could, in fact, make the cures that were being prescribed as deadly as the illnesses they were meant to alleviate. From the over-prescription of the opiate-based laudanum and the popularity of patent medicines that could contain high levels of alcohol or cocaine, to the continued resistance by many doctors to the idea that they should wash their hands or sterilize their instruments during the delivery of babies or routine surgery, remedies in that period could, indeed, be lethal—hence the title I chose for the book.

On the other hand, there were concerted efforts made to improve medical practices, including the introduction of anesthesia and antiseptics and the use of surgery to remove cancerous tumors. In addition, reform movements had begun to appear with the goal of addressing the health problems associated with urban poverty, like overcrowded tenements, adulterated milk, and inadequate sewage systems.

And it was often women, as patients and practitioners, who were at the forefront of these medical and societal reforms. This included two of the pioneering female physicians who lived and worked in San Francisco in 1882, Dr. Charlotte Brown and Dr. Lucy Wanzer. Dr. Wanzer was the first woman to graduate from the University of California’s medical school, and Dr. Charlotte Brown became the first woman in the nation to chair a state medical society.

Even though, by the 1870s, there were a growing number of institutions like the University of California that had opened their doors to women, this was often because they had no other option as public universities. Consequently, there was ample evidence that many if not the majority of male physicians of the day were hostile to women in the profession. Lucy Wanzer faced pointed hazing by male students and professors when she attended medical school, and Charlotte Brown was initially denied membership in the San Francisco medical society, despite her excellent credentials.

Part of this seemed to be based on fears that the new crop of female physicians would be too successful. In national medical journals of the time (including a San Francisco journal), there were numerous articles that complained that the entrance of women into the profession, particularly in the field of gynecology and obstetrics (which was often the most lucrative of part of a doctor’s medical practice), was producing a glut of doctors that would make it hard for men in the profession to make a living.

One of the consequences of this sort of attitude was that many of the general hospitals and clinics in the nation, where men got practical clinical training or sent their patients for treatment, refused to open their doors to women physicians. In response, women turned to their supporters in their communities to set up separate female-staffed institutions to fill this gap.

I was not surprised when I discovered that Dr. Brown and Dr. Wanzer had done something similar. They were two of the founders of the Pacific Dispensary for Women and Children, which provided a walk-in clinic and maternity and other hospital services for women and children and was the first female-run clinic and hospital and first nurses training school in the West. I had found the setting for my new mystery.

I also found my plot when I read about another female physician, who had also founded a hospital for women. Dr. Mary Dixon Jones had founded the Brooklyn Hospital for Women in the 1880s, and at the end of that decade she became the target of a vicious newspaper campaign. In a series of articles, a local paper suggested that Dr. Dixon Jonees had defrauded the local elites who had supported her and her hospital, hinted that she had performed illegal acts (ie abortions), and portrayed her as some sort of deranged woman who conducted the surgical removal of women’s ovaries as part of some twisted desire to deny these the ability to have children. As a result of this newspaper campaign, Dr. Dixon was investigated by local authorities and charged with second-degree murder and manslaughter in the deaths of two of her patients.

Regina Morantz-Sanchez, in her book about Dr. Dixon Jones, Conduct Unbecoming a Woman, describes how this trial revealed the degree of professional jealousy and sexism on the part of the members of the medical community that spoke out against their fellow doctor. It also revealed the degree to which that medical community was divided over the safety of gynecological surgeries, like the ovariotomies that Dr. Dixon Jones performed, in a period when there was still a high death rate associated with any form surgery.

Dr. Dixon was eventually acquitted, but as I read about her experiences and after I read that Dr. Charlotte Brown had been the first woman on the west coast to perform an ovariotomy, I had the main outlines of my plot.

In Lethal Remedies, Annie Dawson (my main series protagonist and an experienced accountant) is asked to help rescue the Pacific Dispensary for Women and Children from financial difficulties and then investigate an apparent attempt to ruin the reputation of the institution and the female medical professionals, like Dr. Brown, who staffed it.

But remember, all of this––the research I did, the development of my plot, even the completed manuscript––occurred before the beginning of the Covid-19 pandemic. However, as I did my last read-through and edits on the book, I couldn’t help but see how inadvertently relevant my cozy mystery had become. Just the number of times I had the doctors and nurses in the book wash their hands in carbolic soap had become significant in the current context, as did the conversation between my characters about how President Garfield, who had recently died, was killed not so much by his assassin’s bullets as by the ineffective and ultimately deadly interventions by his doctors.

I have no doubt that some readers will also see echoes of the late nineteenth century social and medical issues I portray in the novel in contemporary debates over the safety of using untested experimental drugs on Covid-19 patients and the high mortality rates of patients on ventilators.

More importantly, I hope that readers will notice the parallels between the doctors and nurses (fictional and real) in Lethal Remedies, who were dedicating their lives to providing first-rate services to the poor women and children in San Francisco in the spring of 1882, and the brave medical professionals risking their lives every day in 2020 on the behalf of all of us. And that these parallels will indeed provide comfort in this time of the Covid-19 pandemic.

M. Louisa Locke, June 8, 2020