Public Careers and Private Sexuality: Some Gay and Lesbian Lives in the History of Medicine and Public Health

Abstract

This study explores the careers of 5 physicians active in public health and medicine during the first half of the 20th century to illustrate interactions between private and professional life. An examination of these individuals, who might today be variously designated as gay, lesbian, bisexual, transgender, or queer, suggests how historical understanding can be enriched by a greater willingness to investigate intimacy and sexual life as potentially relevant to career and achievements. Further, the narratives support a plea for all historians to provide readers with a more frank acknowledgment of the possible relevance of personal life to intellectual work, even in the sciences.

Additionally, this historical exploration of ways that careers and achievements may have been affected by a person's homosexuality (even when the person did not publicly embrace a gay identity) opens up a new area of research through biographical sketches based on historical sources combined with generalizations that are intentionally provisional. Included are the stories of Sara Josephine Baker, Harry Stack Sullivan, Ethel Collins Dunham, Martha May Eliot, and Alan L. Hart.

In the lives of great people, it is desirable that their family lives are not covered with a veil by their biographers.

Elie Metchnikoff (1915), writing about Robert Koch1

IN 1973, WHEN DR HOWARD Brown, New York City's retired health commissioner, came out of the closet in a speech at a medical meeting, it made the front page of the New York Times and other newspapers around the country.2 That a voluntary disclosure of his homosexuality—with no connection to a personal scandal—was a major news story may seem odd today. After all, over the past 30-some years, the rapid growth of gay and lesbian movements and the appearance of AIDS encouraged many scientists, physicians, and public health professionals to be open about their sexuality. But in the early 1970s, a high-status person's coming out was still newsworthy, even in the wake of the “Stonewall riots” of June 1969 that energized a homosexual rights movement.

Howard Brown made his private life public when another physician asked Brown to speak out as a gay doctor “so that ‘physicians would stop thinking of homosexuals as just hairdressers, interior decorators, and male nurses.’ ”3 Even today, with a widespread awareness and partial acceptance of homosexuals in most segments of society, stereotypes endure and invisibility remains a problem, especially in the science-based fields. Gay people have no presence in the standard histories of science, medicine, and public health.4 Among more than 500 entries in a very recent biographical dictionary of gay and lesbian history, the only gay or bisexual scientists are anthropologists Ruth Benedict and Margaret Mead, economist John Maynard Keynes, and mathematician Alan Turing.5 For a gay or lesbian student wondering what it might be like to pursue a scientific or medical career, history seems to offer no role models.6

Moreover, so few people in science and medicine have been recognized as gay or lesbian that historians and sociologists, even when interested, cannot yet include them in their research on how personal and familial factors have shaped scientific careers and scientific knowledge.7 In the magisterial 18-volume Dictionary of Scientific Biography, a reader repeatedly discovers mother's maiden name, religious background, prep school attended, and marital status.8 But one looks in vain for any acknowledgment of sexual orientation as an aspect of “scientific biography,” and the same silences are found in works like the Dictionary of American Medical Biography.9 If the world can acknowledge the familial basis for the creative collaboration between Marie Curie and her husband Pierre, should not historians of scientific and medical fields likewise be able to open the closet door for homosexuals and their partners without fear of causing scandal?

How thoroughly homosexuality could affect a doctor's career was described by Howard Brown after he came out and participated in post-Stonewall gay activism:

It was my homosexuality that determined my choice of profession—I hoped to solve the riddle of my sexual identity in medical school. It was my homosexuality that determined which city I would live and work in—New York would allow me to lead the sort of life, social and private, that my staunchly gay nature impelled me to. And it was my homosexuality that lay at the root of my decision to resign some eighteen months after I had attained the pinnacle of my profession. At the same time, my professional life repeatedly impinged upon my life as a homosexual, ultimately damaging the relationship that meant more to me than any other … my long-term love affair with Thomas.10

While the frankness of gay liberation was not available to people of the generations studied here, we may still use Brown's personal reflections as a guide in trying to discern ways that the same-sex experiences and the partnerships of private life shaped public careers and were shaped, in turn, by them.

In discussing the private life of people from earlier eras, and especially in placing them in categories with labels that they might not have applied to themselves, historians need to exercise great caution to prevent anachronistic distortions.11 The terms gay, lesbian, bisexual, transgender, and homosexual are used here without the further refinements that would be appropriate in book-length biographies of these people, and within this article such adjectives do not indicate trans-historical and universal categories but are simply a convenient first approximation for calling our attention to specific examples and allowing the exploration of new questions and a new area of research.12

FIVE LIVES, PERSONAL AND PROFESSIONAL

Individual biographies are used here to explore the larger questions without losing the texture of intimacy in people's lives. Some of the interactions of personal life with career highlighted here also appear in heterosexuals' experiences, of course, but others are peculiar to homosexuality and to the antigay oppression that affected both lesbians and gay men (though often in different ways). Additionally, lesbians faced sexism that most men escaped.

Unmarried gay and lesbian physicians in the first half of the 20th century shared many of the same opportunities and difficulties as single people in general. Four of the 5 people discussed in this article remained unmarried, but they all received significant emotional and practical support in their careers from domestic partners (even where they lacked the public recognition of a marriage). These 5 people all made administration a significant part of their careers along with their clinical, research, and other programmatic activities; whether having a supportive partner but no children might have facilitated their pursuit of management responsibilities is perhaps worthy of closer attention.

These homosexuals faced hostility and worked hard at countering discrimination. Usually they tried to avoid being treated as “different” by colleagues. From an awareness of society's reactions to nonheterosexuality, they came to see the world in general from an outsider perspective, even as they were achieving professional advancement, renown, and, in some cases, substantial public responsibility. Some experienced support from and solidarity with others in similar situations and seem to have drawn from those experiences a commitment to working for members of other disadvantaged groups. Among the lesbians, this ambition was cultivated through social and political networking within such same-sex communities as the suffrage movement and settlement house circles. In one case, a physician (Sullivan) developed specific theories and clinical practices based on his personal experience of sexuality. While other examples of historically significant gay and lesbian physicians could have been included in a longer study (e.g., Oswald T. Avery, Alphonse Dochez, Louise Pearce, and William H. Welch), the number of known gay and lesbian figures in the history of science and medicine is still very small.13 Furthermore, at this stage, my historical research has an unavoidable bias favoring people in long-term relationships simply because those partnerships call attention to possibly relevant examples and because the relationships sometimes furnish crucial evidence in a situation where documents of private life have so often been lost or suppressed, especially by homosexuals and their families.

SARA JOSEPHINE BAKER, 1873–1945: MEDICINE, PUBLIC HEALTH, CHILD WELFARE

Working from within the medical profession and the public health bureaucracy, Dr Baker achieved unprecedented breakthroughs in child hygiene and in preventive medicine more generally.14 In 1908, with the groundwork already laid by Baker and her colleagues, an innovative division (later a bureau) of child hygiene was established by the New York City Health Department and placed under Baker's direction. Data from her pilot programs confirmed her argument that infant mortality could be lowered far more by preventive interventions within the family than by delivering medical care to sick babies. To the already established clean-milk stations, Baker added a changing mix of maternal education, wide use of visiting nurses, help for the young girls who often were forced to care for their infant siblings, and improvements in the training of midwives. Her approach was widely copied by other city and state health departments, as well as by the United States Children's Bureau, which opened in 1912. From 1908 to 1918, New York City's infant mortality fell from 144 to 88 per 1000 live births. While Baker's primary focus was infants and children, her successes helped create a place for preventive medicine in general as an adjunct to public health. Baker promised herself she would retire when every state in the union had a child hygiene service, and the spread of her ideas enabled her to do that in 1923 at age 50, although she continued her activism as a consultant to national and international organizations for many years.

Baker's career bridged eras, cultures, and contradictions; through it all, she drew emotional and intellectual support from female partners and a wider circle of feminist friends. She had grown up among Victorian notions of female difference, and she trained at the women's medical college founded by Dr Elizabeth Blackwell and still run by her sister, Dr Emily Blackwell.15 But “Jo” Baker, consciously modeling herself on the fiercely independent Jo in Little Women, cultivated a self-image of being tough when it was required to get the job done, and she recounted many stories about this approach, such as her handling drunken husbands in tenement apartments, forcing vaccinations on men in Bowery flophouses, and being more comfortable working with the political machine of Tammany Hall than with reform administrations.16

Baker took intellectual and emotional pleasure in meeting the engineering, bureaucratic, and public relations challenges of public health, while long maintaining a lucrative private medical practice until her executive responsibilities became too demanding. She adopted a mannish style of dress with tailored suits, high collars, and neckties because it allowed her to reduce the visible anomaly of being a woman in a man's profession. And she loved the story of a medical colleague's moaning to her about the deficiencies of women doctors until she brought him up short by asking, “What kind of creature do you think you are talking to now?” He could only blush and reply that “I’d entirely forgotten that you were a woman.”17 But even if this doctor had momentarily forgotten Dr Baker's sex, people in general did not, and she was forced to surmount the obstacles of gender discrimination throughout her career.

Like many other “new women” of the early 20th century with their successful careers, Baker and her friends played with aspects of masculinity (Baker's partner for many years, the well-known novelist Ida Wylie, was called “Uncle” by close associates), but they did not identify with men's view of things.18 As Wylie wryly explained, “When I hear brave tales about the Pilgrim Fathers I know it was the Pilgrim Mothers who did the dirty work and held the fort. I take off all my hats to them.”19 Wylie and Baker were numbered among the hundred or so women belonging to Heterodoxy, a biweekly luncheon discussion club of free-thinking and free-spirited women, of whom perhaps a quarter were lesbian or bisexual.20 In the mid-1930s, after Baker retired, she moved to New Jersey, where she and Wylie shared a house and farm with another physician, Louise Pearce. Known locally as “the girls,” the three lived together until Baker's death in 1945; Wylie and Pearce continued living there until both died in 1959.21

HARRY STACK SULLIVAN, 1892–1949: PSYCHIATRY

Following a rapid rise to national and international attention in the 1920s, Sullivan remained among the most famous of American psychiatrists through the 1940s. With colleagues, he founded the Washington (DC) School of Psychiatry, the William Alanson White Institute in New York City, and the journal Psychiatry.22 To some he was “the American Freud” or “the man who Americanized Freud.” Recognized for his efforts to establish a unitary theory of psyche and personality development based on the interpersonal event as the basic unit, Sullivan's work paid special “attention to the larger interpersonal world into which each individual is born and struggles to make connections. His vision was of a psychiatry that was fully integrated into the social sciences.” Sullivan published relatively little of his work during his lifetime, and his writing was difficult for many readers. After Sullivan's death, his reputation declined (apparently due in part to homophobia), despite the fact that his “ideas have been thoroughly incorporated into the conventional wisdom of psychiatry.”23

A substantial biography by Helen Swick Perry, who worked with Sullivan late in his career, mentions Sullivan's relationship with Jimmie Inscoe, who lived with him for over 20 years, until Sullivan's death. Although some contemporaries and some historians have regarded Jimmie as an unofficially adopted son, he was Sullivan's domestic partner; and it appears that Sullivan's closest colleagues, friends, and patients (including Margaret Bourke-White, Katharine Dunham, Erich Fromm, Harold Lasswell, Edward Sapir, and Clara Thompson) accepted Jimmie as much as they would have accepted a spouse. But more interestingly, Sullivan's homosexuality was not just a facet of his personal life; it was an important, if long obscured, factor in his psychiatric work—both theoretical and clinical.

Research by Michael Stuart Allen has now established that Sullivan drew deeply and in interesting ways upon his difficult experiences as a gay man. Although Allen's nuanced interpretation of his discoveries is not easily compressed into a brief account, the story may be sketched as follows. In 1925 at Sheppard –Enoch Pratt Hospital in Baltimore, Sullivan was allowed to completely take over a men's unit of schizophrenic patients, from which he excluded other physicians, all female staff, and all male staff except for those he personally selected. As an exploration and an informal therapeutic experiment, Sullivan created for his patients an all-male community and permitted them little contact with outsiders. In this circumscribed world, he intended his patients to experience interpersonal interactions with the comfort and security of preadolescent boys. This included allowing patients to acknowledge homoerotic feelings, since he believed that same-sex interactions were a normal part of preadolescent development on the path to normal heterosexuality and that in these men these feelings had been blocked, leaving them “hopelessly lost in the welter of dream-thinking and cosmic fantasy making up the mental illness.”24 Within this specially protected milieu, patients and staff openly joked around and safely touched and hugged each other. This supportive environment sometimes allowed patients to escape from their private disturbed worlds and to establish more normal interactions with others on the unit. For some patients, significant improvements were reported in what had been taken as irremediable cases; some were released from the hospital to return to their families, at least for some time. In 1929, Sullivan resigned over a budget dispute, ended the experiment, and never published any systematic account of its results.25

Historians of science are both frustrated and intrigued by significant experiments that fail to be written up by the investigator. The puzzle is more challenging when the experimenter's personality is so fully involved. The mystery of Sullivan's theory about youthful homoeroticism and its impact on healthy personality development is made more alluring by Sullivan's active suppression of biographical information about his own youth and, further, by the possibility that he had experienced a nervous breakdown at the time he was suspended from college during his first year at Cornell. Despite the brevity of this account, historians will recognize here a fascinating episode. Now that an explicit search to link Sullivan's homosexuality to his work has been so productive, we may hope that others will follow this lead in showing the effects of homosexuality not just on the career patterns of other scientists and clinicians but on their intellectual work.26

ETHEL COLLINS DUNHAM, 1883–1969: PEDIATRICS, NEONATOLOGY, HEALTH EDUCATION; MARTHA MAY ELIOT, 1891–1978: PEDIATRICS, CLINICAL RESEARCH, PUBLIC HEALTH, CHILD WELFARE

While Dunham and Eliot are each worthy of individual attention, their shared personal life has such an intimate connection with their careers that a combined narrative better illustrates their close relationship of 59 years. They achieved major professional positions at Yale, at Harvard, and in government, even while they were making careful career choices to maintain the continuity of their domestic partnership.27 Each was also accorded public honors for leadership in pediatrics, child welfare, and public health. In 1948, Eliot was the first woman elected president of the American Public Health Association (APHA), and in the same year she was awarded a Lasker Medal. She was the first woman to be honored, in 1958, with the Sedgwick Memorial Medal, the APHA's most prestigious annual award. Both women received the John Howland Medal, the highest honor given by the American Pediatric Society (Dunham in 1957 and Eliot in 1967), the first and second women to receive this award. In 1964, the APHA honored Eliot by establishing the Martha May Eliot Award for outstanding service to maternal and child health.

Eliot and Dunham met in 1910 during their undergraduate days and remained a couple until Dunham's death in 1969. Dunham was 8 years older and entered college in her mid-20s. When Eliot graduated from college a year before her friend, she delayed entry to medical school by a year so they could enter Johns Hopkins together. Graduating very high in her medical school class, Eliot was guaranteed an internship at Johns Hopkins, but when Dunham's application was rejected, Eliot opted instead for one in Boston, where she thought Dunham's prospects would be good. But their plans were thwarted when a wartime shortage in men opened up more places for women at Johns Hopkins and Dunham was given a belated opportunity for a residency there. Despite visits, the year's separation was difficult for them. The next year, they again found coordination of opportunities impossible, with Eliot going to a pediatrics residency at St Louis Children's Hospital and Dunham to New Haven Hospital.

For the following year, Eliot decided to forgo a second year in St Louis to move to Boston, feeling that she could find ways to bring Dunham there. She started a private practice, but her social medicine leanings made her frustrated, until good fortune united the women again—at least in the same city. Eliot was invited to be the first resident physician for Yale's new department of pediatrics. “The only drawback was that the position required Martha to live in the university hospital. Yet she managed to take many of her meals and to sleep often in Ethel's apartment,” Lillian Faderman writes.28 At this time, Eliot's revealing letters to her mother were often on the stationery of “Ethel C. Dunham, MD.” A few years later, when they found a house to share, Eliot wrote her mother about what she called “Excitement no. 1” (new funding for her research) and “Excitement no. 2” (the house). Faderman observed that Eliot “does not hide the fact that although the new house has two bedrooms, she and Ethel sleep in the same room.”29

They both maintained positions at Yale for many years. Even when Eliot took her first post in the US Children's Bureau in 1924 (as director of the child hygiene division), she negotiated an arrangement that allowed her to work mostly from New Haven and spend only about 1 week a month in Washington. Only in 1935, when Eliot was promoted to assistant chief of the bureau and Dunham became the bureau's director of child development, did they move to the capital. While Eliot's tenure as assistant and then associate chief from 1935 to 1949 and her return from international work to serve as chief from 1951 to 1956 are well known, those titles belie the importance of her contributions. Regarding the long tenure of Katharine Lenroot, who was made chief in 1935 and served until 1951, one historian has observed that the Children's Bureau had “some glorious moments, but these were often triumphs engineered by Martha Eliot.” In fact, Eliot had been a leading candidate for chief as early as 1935, backed by the male-oriented forces in pediatrics and opposed by much of the female-oriented social work establishment.30

Eliot and Dunham produced important scientific research that should not be overshadowed by their achievements in administration and policy. Dunham's work helped pediatricians gain a place alongside obstetricians in the nursery. Working through the American Pediatric Society and the Children's Bureau, she established standards for care of newborns, both full term and premature. She endeavored to bring the latest ideas on the care of infants from the hospital into the community with such innovations as discharge planning and coordination with health departments. She also exerted wide influence through popular writing and lecturing on the practical applications of the new knowledge and standards.

Eliot's most famous research contributions were studies of rickets. It had recently become known how rickets, once diagnosed, could be relieved by nutrition supplements, but Eliot realized that expensive diagnosis and intensive therapy would not save enough children from this widely prevalent scourge. Through x-rays she improved the early diagnosis, and she coordinated the studies that established minimum daily requirements for vitamins so that all children could be saved through cheap, universal prevention.31

Neither woman's obituary in the New York Times mentions their domestic partnership, but the opening line of Eliot's offers an image that fits them both; it called Dr Eliot “an unmarried woman who devoted her life to problems of maternity and child care.”32 This appreciative characterization would apply equally to Dr Baker and a fair number of other lesbians in medicine and social service for the decades prior to mid-century. For many of the lesbians in public service, their relationships and careers were mutually supportive, and Eliot's predecessor as bureau chief, Katharine Lenroot, also lived with a female companion.

But such public-spirited single women were not always respected. The aggressive, public homophobia that Eliot, Dunham, and others faced at times is indicated by such comments as these by Senator James Reed of Missouri, in a tirade against the Children's Bureau in 1921 printed in the Congressional Record. Mocking what he called “female celibates . . . too refined to have a husband,” his speech provoked repeated outbreaks of laughter when he proclaimed that “it seems to be the established doctrine of the bureau that the only people capable of caring for babies and mothers of babies are ladies who have never had babies.” He sarcastically proposed a “committee of mothers to take charge of the old maids and teach them how to acquire a husband and have babies of their own.”33 The journal of one state medical society asserted that the Sheppard–Towner Act to promote the welfare and hygiene of maternity and infancy was “sponsored by endocrine perverts [and] derailed menopausics.”34

Attacks based on this newly popular imagery connecting hormones with sex differences and sexual orientation were directed even at the women's heterosexual allies, such as Dr Edwards Park, a married man who publicly supported Dr Eliot when the Children's Bureau was under attack. In 1930, Dr Haven Emerson (former health commissioner of New York City and then dean of the Columbia University School of Public Health) charged Dr Park, professor and chair of pediatrics at Johns Hopkins, with having “rushed, in an endocrinological manner to the aid of embattled feminism.” Ironically, Dr Parks's support of Dr Eliot was not just public and professional; it was personal and familial as well, illustrating how these domestic partnerships were warmly supported by professional colleagues. Park frequently closed his letters to Martha Eliot with “Give my love to Ethel.”35

ALAN L. HART, 1890–1962: MEDICINE, PUBLIC HEALTH, RADIOLOGY

Dr Hart is the least famous of our examples, but his life reveals other aspects of the often invisible adjustments and compromises made by queer people of earlier generations in the quest for personal and professional happiness. Hart was a public health physician, a tuberculosis (TB) expert, and a medical administrator. Additionally, Hart was a successful writer, the author of 4 novels and a popular book about x-rays in medicine. While his 5 books, which appeared between 1935 and 1943, are little known today, they were published by major houses and reviewed in the New York Times. A dust-jacket author's photo from about 1943 is shown at left.

Alan Hart was born in 1890 in Kansas and raised in Oregon. Hart graduated from Stanford in 1912 and earned a medical degree from the University of Oregon in 1917. He married the next year and divorced 7 years later. In 1925, when associated with the New York Post-Graduate Hospital, Hart married Edna Ruddick, a social worker with a graduate degree from Columbia and expertise in tuberculosis. In 1930, Hart earned a master's degree in radiology from the University of Pennsylvania and worked at the Henry Phipps Institute in Philadelphia. For most of the 1930s and through the war, he worked in TB control in Idaho, also reading recruits' chest x-rays for the military in Seattle. In 1945, Hart became Connecticut's director of TB control, hospital care, and rehabilitation; he retained this position for 17 years, until his death at age 72. Shortly after arriving in Connecticut, Hart had earned a master's degree in public health from Yale. Dr and Mrs Hart resided in suburban Hartford, and they belonged to the Unitarian meeting there from 1945 until Dr Hart's death in 1962. Mrs Hart continued living there until her death in 1982.

Dr Alan Hart's public life is not an especially striking career (except for his being a physician novelist), and his importance to this selection of gay lives is not obvious. His place in this study is, however, not as a gay or bisexual man. Alan Hart was, in fact, born and raised as Alberta Lucille Hart.36 A yearbook photograph of Hart at age 21 is shown below; Alberta Hart is at the upper right. After earning a medical degree in 1917, Alberta Hart chose to live as a man—publicly, professionally, and personally. And he succeeded through postgraduate education at Yale and the University of Pennsylvania, positions of substantial executive responsibility, success as a novelist, and 2 marriages to women (the second lasting 37 years).

Hart's choice of a masculine persona might have been a shield from discrimination and homophobia, or it might have been the realization of a deeper sense of identity. Unfortunately, the historical record is very thin, and we have no personal documents to help us understand the choices made in his long and productive career. For Hart, we can only put on record the outward facts and acknowledge that we are likely to remain sadly ignorant of his intimate life and his feelings. Hart died in 1962, about a decade before an activist movement broke the power of antigay forces in psychiatry and long before transgender activists started making some headway in challenging the gay/lesbian movement on its binary views of sex and gender identity.

CONCLUSION

These lives illustrate some ways that private sexuality, sexual orientation, and public careers affected each other and indicate how this interaction sometimes shaped intellectual achievements. For Hart, there seems to have been little connection between his personal situation and the intellectual content of his professional work; in contrast was Sullivan's career, in which homosexuality played a major role. For Baker, Dunham, and Eliot, the connection of public and private life, if one can be discerned, seems clearest in the empathy they brought to meeting the needs of the women and children whom they served, as well as in their lifelong commitment to bettering the circumstances of the disadvantaged. For all five, professional success depended heavily on the emotional support and professional assistance provided by a long-term partner who was recognized and accepted by colleagues as part of the scientist's family unit. When these historical questions are pursued in further studies and the number of examples increases, research will surely find more connections between the private and the public than this small cluster of brief stories can suggest.

As noted earlier, certain of the features of these lives would appear as well in the history of heterosexual scientific careers, but many are peculiar to the nature of antigay oppression. For these people, the most common self-protective strategy was silence: simply “staying in the closet.” Yet with careful management, this approach did not isolate them, and they enjoyed the informal networks of same-sex communities. Except for Hart, they lived relatively frank lives while stopping short of the public declarations that became both safer and more helpful after a gay liberation movement had begun. A 19th-century observation—that people make their own history but do not get to choose the circumstances in which they make it—has been a steady guide in this study's attempt to understand these people's lives in a scientific, historically sound, and contextual manner, while not denying ourselves an emotional engagement with them across the decades and an appreciation for their lives and achievements.

1.

S. Josephine Baker, MD, date unknown. (Photograph courtesy of National Library of Medicine, Bethesda, Md.)

2.

Harry Stack Sullivan, MD, photographed by Margaret Bourke-White, ca. 1935. (Photograph courtesy of The Washington School of Psychiatry, Washington, DC.)

3.

Martha May Eliot and Ethel Collins Dunham during their medical studies at Johns Hopkins University, ca. 1916. (Photograph courtesy of Schlesinger Library, Radcliffe Institute, Harvard University, Cambridge, Mass.)

4.

Alan L. Hart, MD, on the dust jacket of These Mysterious Rays, 1943. (Photograph from author's collection, New York, NY.)

5.

Alberta Lucille Hart (upper row, far right) in Albany College Yearbook, 1911, among yearbook's editorial staff with stuffed owl as mascot. (Photograph courtesy of Lewis and Clark College Archives, Portland, Ore.)