Birth Control, Sex Education, and Eugenic Feminism: The Peculiar Activism of Women Physicians

 From the collections  Comments Off on Birth Control, Sex Education, and Eugenic Feminism: The Peculiar Activism of Women Physicians
Sep 122019

-by Sebastian Porreca, Archives Intern

Birth control, family planning, and sexual education have had significant impacts on sexual health and how people think about sex across the globe. Each of these public health subjects have a long and storied past in the United States, but the culminating moment in all of these histories was the push to publicize them in the early 20th century. Many of us can not imagine a time without the prominent, albeit sometimes controversial, features of women’s health and public health such as family planning and sex education. The so called “social hygiene movement” began gaining steam around 1910, placing an emphasis on ending prostitution, advocating for contraception to decrease unwanted pregnancies, and focusing on preventive medicine. Leading the way in the social hygiene movement were a number of prominent women physicians, such as Dr. Elizabeth Blackwell and Margaret Sanger, who pushed for the representation of women in medicine, and presented a new emphasis on health issues regarding women. The prevalence of women in the social hygiene movement stemmed from long standing, patriarchal gender roles that positioned women as caregivers, nurturers, and child bearers, who, by extension, felt the need to project these instincts onto society as a whole and morally nurture society. It is a case by case basis whether these women, who were in many senses far more progressive than these gender roles, actually believed and coalesced to these expectations, or utilized them to further the causes of professional women, and there is evidence that can be presented for both. Either way, the programs many of these women pushed were far more progressive than their time. They sought to erase the stigma around sexual urges, teach sex education to young women, and decrease deaths caused by clandestine abortions and unplanned pregnancies. However, there was a dark side to the progressive pushes made by these feminist physicians.

A major current in the social hygiene movement was the concept of eugenic feminism, which asserted that women were the bearers of the next generation of the “race” and therefore had the legal right to vote and politically advocate for interests concerning them, their children, and the “race” as a whole. A clear example of this ideology is a speech given by Dr. Margaret Clark in May, 1915, later to be reprinted in the Woman’s Medical Journal in June, 1915. The speech/essay basically asserts that women physicians are an elevated group of “mothers’ helpers” who turn to medicine out of their natural and God given maternal instincts. With this innate caregiver ability, women physicians, in Dr. Clark’s thinking, are a natural progression of motherhood that allows them to advise and assist new mothers, care for and morally develop children, and deal with the “ignorance” and irrationality of new mothers and women patients that men don’t have the patience to deal with. Women physicians who perform outside of these caregiver roles are downplayed. Furthermore, due to this projection of the caregiving and morally superior nature of women onto society as a whole, Dr. Clark asserts that “a new day has come for the motherhood of the race.”  

It would be both unfair and false to claim that every woman or woman physician involved in projects regarding social hygiene or suffrage were believers of eugenic feminism. Nonetheless it is important to recognize how the eugenics movement influenced the ideas of women social hygienists. A significant example of this is the issue of birth control, a large aspect of the social hygiene movement. The push for birth control, led by Margaret Sanger, sought to combat the various problems caused by unintended pregnancies and unintentionally large families. These problems included not only health issues and deaths caused by the strain of multiple pregnancies or an illegal abortion, but also the financial strain and lack of necessary resources for impoverished families to raise these unintended children. These are often arguments used today in favor of birth control and family planning, and were by all means very progressive for the early 20th century, but many birth control advocates also heavily relied on eugenics to support their position.

The prominent social hygienisist  Dr. Lydia Allen DeVilbiss perhaps exemplifies this position best. On one hand, Dr. Dee (as she was known) was a huge proponent of affordable, accessible birth control, and even opened the first long running birth control clinic in New York City, working closely in New York with Margaret Sanger. In a letter to Dr. Bertha Van Hoosen dated October 12, 1937, Dr. DeVilbiss describes how she went on to develop affordable contraceptives “costing about 50 cents per family per year which… shows a high rate of efficiency.” However, despite her actions in the field of birth control, her intentions and ideology around these actions were ultimately hinged on eugenics and concepts of racial purity.

The Letter Dr. Lydia Allen DeVilbiss wrote to Dr. Bertha Van Hoosen in 1937 detailing her work in preventive medicine and birth control. (Letter from Dr. Lydia Allen DeVilbiss to Dr. Bertha Van Hoosen. 12 October, 1937. The Bertha Van Hoosen Papers. Box 1, Folder 2. Drexel College of Medicine Legacy Center.) 

In a chapter of her 1923 work titled Birth Control: What is It? Dr. DeVilbiss explains quite frankly that the aim of accessible, legal, and affordable birth control is not necessarily to help the plight of impoverished, marginalized communities. Rather, it is intended to make sure that they can utilize birth control and therefore procreate less. In her reasoning, if birth control is illegal or expensive, only the rich and powerful could access it, which would mean that the birth rate of the “better stock” would decrease. By her extension, then the “poor, ignorant, insufficient, and the dullards” would be able to procreate freely, surpass the “better stock” in birth rate, and overall taint the “American race.” If this isn’t shocking enough, Dr. DeVilbiss was also a huge proponent of forced sterilization, with hundreds of patients “of low intelligence” being sterilized against their will at her Mother’s Health Clinic in Dade County, Florida. 

Dr. Lydia Allen DeVilbiss on the cover of the October 1944 edition of Medical Women’s Journal in which she was interviewed. (Medical Women’s Journal. vol. 51 no. 10, October 1944. Drexel College of Medicine Legacy Center.)

Certainly not all women were as adamant and frank on their views of eugenics as Dr. DeVilbiss. Many women physicians were genuinely concerned with issues affecting impoverished, marginalized communities, and made great strides to aid communities with these public health issues. However the language and ideas used by physicians like Dr. DeVilbiss made their way into most mainstream discussions of social hygiene at the time, even if these discussions were not focused on eugenics or racism. For example, the October 1928 report from the Medical Women’s National Associate (MWNA) Committee on Race Betterment, despite the less than desirable name, presented some really progressive and ahead of their time opinions on sex and gender. The author of the report, Dr. Rachelle Yarros, links the subjugation of women, and patriarchal structures with the vast stigma surrounding sex and sexuality, and pushes that sex education and birth control are a necessary path to break this stigma. Dr. Yarros’ report also details birth control clinics opened in poor immigrant neighborhoods, but, unlike Dr. DeVilbiss, Dr. Yarros showed a genuine care and desire to help impoverished immigrants. Still, this eugenics-esq language often seeps into her report, most obviously in the fact that the committee she is reporting from is called the Committee on Race Betterment, but also in her decision to use “racial stock” as a factor in her data gathering. 


 The report from MWNA’s Race Betterment Committee written by Dr. Rachelle Yarros in 1928. (Yarros, Rachelle, M.D.. “Excerpts from Report Race Betterment Committee”. Quarterly Bulletin of the Medical Women’s National Association. No.22, 12-13, October 1928.)

This example serves to show how pervasive the language of eugenics and racialism was in the social hygiene movement, even if the activism of women like Dr. Yarros were not necessarily focused on sterilization, racial culling, or eugenics. This is a little uncomfortable for those looking today at the social hygiene movement, but it serves as an important lesson in understanding the public health services that continue to benefit so many. Unfortunately, the language and terminology included in many writings on social hygiene from the 1910s through the 1930s borrowed from and used the then popular science of eugenics. This was not because all social hygienists or advocates of women’s health were firm believers in eugenics and racial purity, but rather many  simply deployed the lexicon they knew and what they were taught. With that in mind, we should not negatively judge every woman who used this terminology that, by today’s standards, is socially unacceptable and demeaning. We can not discount these women simply by the language that they used, but rather we need to closely analyze the actual actions and programs they implemented for the sake of their perceived “good” and observe the actual ideology behind these programs. This does not in any sense justify the horrific outcomes of eugenics or justify those who supported eugenics and racial cleansing, but it gives us a context in which to view the women who participated in the social hygiene movement and ultimately made it possible to have access to contraception, birth control, and sex education. In understanding the whole picture of how we got these innovations in women’s health and public health, it is important to not just observe the good, positive aspects, but also acknowledge and understand the darker side of these innovations. This allows us to truly and honestly observe how social movements function and learn from our past in order to make social movements and medical advocacy more ethical and inclusive for all. 

Special thank you to Elliott Earle! The sources and notes they gathered on eugenics/social hygiene were a huge help to me in writing this, and I am very thankful for their help!


Allen DeVilbiss, Lydia, M.D.. “Increase In Populations” Birth Control: What is it?” Ch. 5. 67-73.  (Small, Maynard and Company, 1923). 

Cecily, Devereux. “Woman Suffrage, Eugenics, and Eugenic Feminism in Canada” Women’s Suffrage and Beyond. 1 October, 2013. 

Clark, Margaret Vapuel, M.D.. “Medical Women’s Contribution to the Education of Mothers.” Women’s Medical Journal, 25:6 (June 1915) 126-128. (Presentation, 18th Annual Meeting, Women’s Medical Society of Iowa, Waterloo, Iowa, May 1915.)

Letter from Dr. Lydia Allen DeVilbiss to Dr. Bertha Van Hoosen. 12 October, 1937. The Bertha Van Hoosen Papers. Box 1, Folder 2. Drexel College of Medicine Legacy Center. 

Safford, Pearl interviewing Allen DeVilbiss, Lydia, M.D.. “An Interview” Medical Woman’s Journal, vol. 51, no. 10, (October 1944) 29-34. 

Yarros, Rachelle, M.D.. “Excerpts from Report Race Betterment Committee” Quarterly Bulletin of the Medical Women’s National Association. No. 22, 12-13 (October, 1928). 

 Posted by on September 12, 2019

Tea at the Turn of the Century: Exploring Small Town Life with Elizabeth Cisney Smith

 From the collections  Comments Off on Tea at the Turn of the Century: Exploring Small Town Life with Elizabeth Cisney Smith
Sep 052019

-By Jacob Griffith-Rosenberger, Digital Imaging Technician

In the summer of 2019, I digitized part of The Isabel Smith Stein collection on Elizabeth Cisney Smith1. This collection includes school materials, diaries, memoirs, medical practice records, personal correspondence, photographs, audio recordings, and other writing and research related to Dr. Smith. Isabel Smith Stein (Dr. Smith’s daughter) compiled this collection to create a biographical record of her mother’s unique life. It was donated to the Drexel College of Medicine by Elizabeth Bouvier (Dr. Smith’s granddaughter) and processed by a Hidden Collections Initiative for Pennsylvania Small Archival Repositories (HCI-PSAR) intern at the Legacy Center in 2015, Daniel DelViscio. A portion of Dr. Smith’s personal correspondence will be included in the latest phase of “In Her Own Right: A Century of Women’s Activism, 1820-1920”, a National Endowment for the Humanities grant-funded project by the Philadelphia Area Consortium of Special Collections Libraries (PACSCL). This phase digitizes more historical material reflecting women’s activism leading to the women’s suffrage movement and celebrates the 100th anniversary of the adoption of the 19th Amendment to the US Constitution in 1920, which gave women the right to vote in all 50 states.

Who was Elizabeth Cisney Smith?

Elizabeth Cisney Smith was born in 1881 in Huntingdon County, PA and graduated from Woman’s Medical College of Pennsylvania in Philadelphia in 1911. She practiced medicine as a general practitioner and in public health in Pennsylvania, Ohio, North Dakota and Maryland until she retired in 1946. Dr. Smith was a prodigious letter-writer and her personal correspondence runs from 1897 to 1962. Her correspondence from 1897 to 1914 is being included in the “In Her Own Right” project due to Dr Smith’s activity related to women’s rights and the suffrage movement. Most notably, she founded a regional chapter of the Business and Professional Women’s Club in Ohio. Her writings also describe turn of the 20th century life in several communities in Central and Western Pennsylvania, attending Woman’s Medical College of Pennsylvania, and living through the Great Depression and World War II.

Elizabeth Cisney Smith and Augustus Edwin Smith around the time of their marriage in 1903. They lived in Fayette County, PA for three years while keeping a farm and teaching school. In 1906, they both entered medical school in Philadelphia. (J.W. Ward, Connellsville, PA/WM.2007.002, Box 14, Legacy Center, Drexel University College of Medicine)

Elizabeth Cisney and Augustus Edwin Smith met at the State Normal School in California, Pennsylvania (now California University of Pennsylvania) while studying to become teachers. In 1901, they became engaged to be married. While living apart before and during their engagement, they exchanged multiple letters per week. Elizabeth’s letters to Edwin are filled with her detailed observations of small town life in Mt. Jewett (McKean County) and later Tyrone (Blair County), Pennsylvania. The letters are framed as an ongoing conversation in which she shares her daily activities, thoughts, and desires. While Tyrone has an active historical society, there are no local history projects currently ongoing in Mt. Jewett, so these letters provide an illustrative look into this community’s past. (For an excellent local history project on another area of McKean County, check out Planet Smethport.) What I found most engaging about Elizabeth’s letters were the anecdotes she included about daily life. One anecdote that I found particularly curious was about tea in Mt. Jewett.

What’s this about tea?

In the spring of 1901, Elizabeth Cisney was 19 and living with her family in Mt. Jewett. At the time, Mt. Jewett was a small rural town supported by extracting natural resources like coal, lumber, oil, and natural gas, small scale manufacturing, and railroads (Planet Smethport Project, n.d.). She enjoyed going to church, singing in a choir, and going on outings with friends. In early spring 1901, Elizabeth wrote a letter to Edwin about a young woman who was “advertising tea” in a Mt. Jewett store. Feeling that the woman was too cooped up in the store, Elizabeth took her for a walk around town. Elizabeth wrote that the woman “makes [the tea] and offers a small cupful to each customer. It is new here and so many people go into the store to sample the tea and don’t usually leave without buying” (quotations are from the page shown below). For me, this anecdote raises a lot of questions. This tea was a popular new product for Elizabeth’s neighbors, but what kind of tea was it? It’s surprising to me that tea, served hot, would have been particularly unusual in a small town in rural Pennsylvania in the early 20th century.

Page from Elizabeth Cisney’s early spring 1901 letter to Augustus Edwin Smith discussing tea in Mt. Jewett. (WM.2007.002, Box 3, Folder 7, Legacy Center, Drexel University College of Medicine)

Black, green, and even oolong tea were all imported to the United States in the 19th and early 20th centuries and were not particularly unusual. However, two notable and uniquely American developments in tea did appear around the time of Elizabeth’s letter: tea bags and iced tea. Tea bags did not become widely popular until the mid-20th century, but the first U.S. patent for a tea bag was filed on August 26, 1901 by two women from Milwaukee, Roberta C. Lawson and Mary Molaren (Begley, 2015). Unfortunately, unless Lawson and Molaren were testing the commercial success of their invention in rural Pennsylvania the spring prior to filing their patent, then Elizabeth was not writing about bagged tea. Iced tea is found in at least two American cookbooks from the late 19th century, but only became popular nationally after the 1904 St. Louis World’s Fair (Danovich, 2015). Additionally, iced tea would probably not have been a big seller in Mt. Jewett at this particular moment, since Elizabeth notes in the same letter that it was still very cold there. Certainly, both of these modern American tea preparations were very unlikely to be found in Mt. Jewett in early spring 1901. Of course, there are nearly infinite explanations for this tea anecdote to imagine, but one other interesting possibility stands out.

While tea was not uncommon in the United States at the turn of the 20th century, it could still be expensive. But at the end of the 19th century, Sir Thomas Lipton began to make tea more affordable. He owned a successful grocery store chain in the United Kingdom and created the Lipton tea brand after buying his own tea estates in Sri Lanka. Lipton was able to sell his tea for less than his competitors by boosting production and prepackaging it in standardized quantities. Lipton successfully introduced his tea to the United States in 1893 at the World’s Columbian Exposition in Chicago (Koehler, 2016). Of the timely changes to tea consumption in the United States, this seems like the most likely explanation for Elizabeth Cisney’s claim about tea being new to Mt. Jewett. While Elizabeth and her neighbors were likely familiar with tea, it had never been affordable for most of them before. This young woman was probably advertising Lipton tea or another prepackaged brand with similarly low prices. This was boxed, canned, or tinned tea, but not bagged. That event was remarkable enough to make it into one of Elizabeth Cisney’s many letters to Augustus Edwin Smith.

This might not be the most historically significant detail or engaging anecdote to come out of Dr. Smith’s correspondence, but it does provide a window into life in Mt. Jewett in 1901. All archival resources have multiple significances and research values. The greatest interest in Dr. Smith’s correspondence likely comes from researchers studying women physicians from immediately prior to World War I to immediately after World War II. In this context, her collection is made all the more valuable by including information on advocating for women’s suffrage, organizing professional women, the Great Depression, and caring for a wartime manufacturing community during World War II. However, other resources for specifically researching Mt. Jewett in the early 20th century are limited. Clearly, Dr. Smith’s early correspondence is valuable for this unique purpose too. Who knows? Someone might even want to determine the pads of paper on which Elizabeth Cisney wrote her letters. You can see the watermarks.


Begley, Sarah. 2015. “A Brief History of the Tea Bag.” Time, September 3, 2015.

Danovich, Tove. 2015. “As American As Iced Tea: A Brief, Sometimes Boozy History.” The Salt (blog), NPR. June 9, 2015.

Koehler, Jeff. 2016. “How Lipton Built An Empire By Selling ‘Farm To Table’ Tea.” The Salt (blog), NPR. October 25, 2016.

Planet Smethport Project. n.d. “The Beginnings of Mt. Jewett, Pennsylvania.” Planet Smethport Project 2019. Accessed July 24, 2019.

 Posted by on September 5, 2019