Category: History

The Dark History Behind American Gynecology

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by Lauren Earhart

In the early nineteenth century, the US slave trade was a major economic driver. Owning healthy, hard-working slaves was considered to be among the most important forms of capital. Additionally, having fertile slaves that could birth and produce more slaves for posterity was vital in order to keep the slave market alive. This became especially true after the ban on non-domestic slave trade in 1808.1 As the demand for slave labor increased, owners began to show increased interest in the reproductive health of their female slaves. This, combined with doctors’ interest in medical experimentation and their need for research subjects, led to unethical gynecological practices on enslaved women. 

As the slave economy grew, the Deep South became a breeding ground for experimental hospitals seeking the next medical innovation. Doctors chasing fame and fortune exploited the maladies experienced by enslaved people in order to establish and perpetuate their medical reputations. Dr. Paul Eve was one such doctor; in 1850 in Augusta, Georgia, he conducted the first successful complete hysterectomy in the US. The surgery was performed on a young slave named Mary, who had complained of vaginal bleeding and infertility for the majority of her life. Dr. Eve, a renowned surgeon in the South, diagnosed the young woman with cancer and formed a team to excise the cancer. When Mary died three months after the surgery, she did not understand that the surgery rendered her infertile and, therefore, devalued in the eyes of her owners and husband. Mary never got the full story of her surgery, and died without ever understanding the risks Dr. Eve had imposed on her against her will. Dr. Eve never took responsibility for his actions, writing, “The history of diseases among our negro population is generally very imperfect and unsatisfactory, and this is especially true as regards uterine derangements.”2

The First Ovariotomy by George Kasson Knapp depicts Dr. Ephraim McDowell’s famous surgerya.

Dr. Ephraim McDowell, the “Father of the Ovariotomy,” which is the surgical removal of one or both ovaries, also owed much of his success to dark, unethical medical practices. After successfully performing an ovariotomy on a white woman, McDowell sought out more subjects to practice his surgical technique on. Not surprisingly, these surgical subjects were enslaved women. Remarkably, in the early 1800s, he was able to locate four slaves with ovarian tumors in the small town of Danville, Kentucky for surgical practice. As Dr. McDowell gained notoriety, Black community members began to fear him. McDowell developed a reputation for causing harm and death in his Black patients without ever truly experiencing any repercussions. As stated by his granddaughter, Mary Young Riddenbaugh, “The negroes of the village and the surrounding country being naturally ignorant and superstitious, whenever they spied Dr. McDowell walking in the distance, would rush into the nearest building, fearing that he might waylay and maltreat them. They feared him as they would some beast of prey.” McDowell’s work advanced the field of gynecology, but the slaves he worked on suffered through painful, unethical surgeries in order to make this happen. However, McDowell’s peers still discredited his techniques and the sacrifice of the enslaved women by stating, “Negresses . . . will bear cutting with nearly, if not quite, as much impunity as dogs and rabbits.”2

Diagram of the vaginal speculum from
On the Treatment of Vesico-Vaginal Fistula by
Dr. James Marion Simsb.

The most famous pioneer of gynecology was perhaps the most unethical and cruel. Dr. James Marion Sims, also known as “The Father of Modern Gynecology,” gained prestige and fame from his work in developing the vaginal speculum (a tool used to examine the vaginal canal and cervix) and a surgical technique for repairing vesicovaginal fistulas. A vesicovaginal fistula occurs when an opening develops between the bladder and vagina, and it often occurs as a result of difficult labor during childbirth. This medical condition was common in female slaves, and was of special interest due to slave owners’ desire to have their slaves in optimal reproductive health. Upon moving to Alabama, presumably to secure a steady supply of test subjects and chase medical renown, Dr. Sims opened a crude hospital on his own property dedicated to perfecting his surgical techniques on enslaved women. He devoted nearly five years of his career to experimenting on these poor, defenseless women.2 We only know the name of three women: Lucy, Betsy, and Anarcha. He subjected Anarcha to approximately thirty surgeries over the course of these five years. At the time of her first surgery, Anarcha was only 17 years old.1 Anarcha’s story was played out again and again for the other thirteen slaves Dr. Sims housed at his primitive hospital, all enduring grueling surgeries until the day Sims finally created a successful technique for treating vesicovaginal fistulas. 

Even more horrifying, Dr. Sims rarely utilized anesthesia during his surgeries on slaves, even though it was available and an accepted surgical practice at the time. Other medical practitioners of the time followed a similar anti-anesthesia philosophy for treating Black patients. This was rooted in the prejudiced belief that Blacks were capable of enduring more pain than whites. It was a common belief that Blacks had thicker skulls, thicker skin, and less sensitive nervous systems compared to other races.1 These beliefs provided false moral justification to the decision to withhold anesthesia and perpetuated the unethical and cruel medical practices conducted on female slaves.

A plaque dedicated to Dr. Simsd.

Unfortunately, many of the prejudiced beliefs and practices experienced by female slaves persist in today’s society. Studies have found that many medical practitioners are prone to underestimate the pain experienced by their Black patients.5 In 2016, a study found that approximately forty percent of first- and second-year medical students endorsed the idea that Blacks have thicker skin than whites. Stemming from these beliefs, an analysis over 20 years of research revealed that Black patients were 22% less likely to receive pain medication than white patients in a variety of settings.3 Additionally, infant mortality rates are 2.3 times higher in Black populations compared to non-Hispanic white populations. This fact is especially ironic, given that the bodies of Black women were sacrificed to advance the fields of obstetrics and gynecology. Not surprisingly, these past abuses have led to a legacy of distrust between the Black community and the still largely white medical profession. As put by authors Dr. Dierdre Owens and Dr. Sharla Fett, “How does a community learn to trust doctors whose forefathers were interested only in repairing and restoring Black women’s reproductive health so that slavery could be perpetuated?”4

The statue of Dr. James Marion Sims that was tore down in Central Park in 2018d.

The impacts of the unethical gynecological practices on enslaved women still reverberate today. The field of gynecology was advanced at the expense of these women; without the experimentation they endured, innovations in diagnostic and curative techniques would not be nearly as advanced as they are today. Therefore, the field of gynecology owes both an apology and debt to the often nameless Black women who sacrificed their bodies and minds to endure the cruel practices of white doctors. Mary, Anarcha, Lucy, Betsy, and the countless other women need to be acknowledged for their contributions and involuntary participation in unethical experimentation. To this day, a hospital is named after Dr. Ephraim McDowell, with their slogan claiming “Excellence is Our Only Standard.” After becoming the president of the American Medical Association, Dr. James Marion Sims had a statue erected in his honor in New York, which was only recently tore down in 2018. Perhaps instead of giving these unethical men credit and recognition, we should name hospitals and build statues that honor the sacrifices of the women they experimented on. In order to reconcile the disparities and improper distribution of recognition, understanding the history of the field of gynecology is essential. True equality in medical treatment for the Black community and other People of Color can not be achieved until the historical roots of biases and prejudices are identified and acknowledged.

References

  1. Bachynski, K. (2019, April 1). Perspective | American medicine was built on the backs of slaves. And it still affects how doctors treat patients today. The Washington Post. https://www.washingtonpost.com/news/made-by-history/wp/2018/06/04/american-medicine-was-built-on-the-backs-of-slaves-and-it-still-affects-how-doctors-treat-patients-today/. 
  2. Owens, D. C. THE BIRTH OF AMERICAN GYNECOLOGY. In Medical Bondage Race, Gender, and the Origins of American Gynecology (pp. 15–41). essay, University of Georgia Press. 
  3. Sabin, J. A. (2020, January 6). How we fail black patients in pain. AAMC. https://www.aamc.org/news-insights/how-we-fail-black-patients-pain. 
  4. Owens, D. C., & Fett, S. M. (2019). Black Maternal and Infant Health: Historical Legacies of Slavery. American Journal of Public Health, 109(10), 1342–1345. https://doi.org/10.2105/ajph.2019.305243 
  5. Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proceedings of the National Academy of Sciences, 113(16), 4296–4301. https://doi.org/10.1073/pnas.1516047113

Image Sources

a. First Ovariotomy: Onondaga Historical Association. https://www.cnyhistory.org/2020/05/the-first-ovariotomy/ (Public Domain).

b. On the treatment of vesico-vaginal fistula: Archive.org. https://archive.org/details/67130240R.nlm.nih.gov/page/n7/mode/2up (Public Domain).

c. James Marion Sims, Father of Modern Gynecology: Thomas Hawk. https://www.flickr.com/photos/51035555243@N01/50232839381 (Public Domain).

d. NYC – Central Park – J. Marion Sims: Wally Gobetz. https://www.flickr.com/photos/70323761@N00/786104189 (Public Domain).

Trailblazers of the United States: Elizabeth Blackwell, MD

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The United States of America began with a fight for representation. Every moment of this country’s history has been marked with strides towards true freedom for all. Women in America have had to fight for every right that they currently have, and be activists for this cause today. Over the past 150 years, the role of the traditional American woman has evolved from a domestic housewife to professor, soldier, medical professional, and so much more. STEM (Science, Technology, Engineering, and Mathematics) have historically been comprised of male-dominated fields, with the few exceptions of trades traditionally seen in a feminine light. In an era of great change, we should look back and see who we have to thank for beginning the fight for equality that we are still advocating for today¹.

Prior to the 1860s, medicine was administered by practitioners with no formal education. In the 1850s one could practice medicine as an “unlicensed physician”. An unlicensed physician was a person who apprenticed under a licensed physician until they had enough knowledge to begin practicing medicine on their own. However, these individuals had no formal education from a medical school and were likely a huge liability. This likely made the medical field more diverse, and there were a handful of women who practiced unlicensed. However at this time there were no licensed female physicians⁵. 

Despite this bustle in the administration, women in early medicine were still confined to traditionally feminine roles and had positions such as midwives and herbalists². In the early 1800s women were not allowed to attend college, so they trained through apprenticeships to do mundane, non-medical tasks such as cleaning floors, washing dishes, and feeding patients³. Still, nursing did not become a career that could be gained via education until Florence Nightingale’s time in the 1860s. This new wave of nursing was eventually brought to America when Bellevue Hospital School of Nursing became the first nursing institute in the United States⁴.

The women that braved medical work faced great discimination, even amongst themselves. Florence Nightingale herself once said that “nurses are not ‘Medical Men’”, and to “avoid the semblance of encouraging such gross ignorance”⁶. However, this did not stop these trailblazing women from prospering. Let’s take a look at the story of the first women in the United States to earn a medical degree, Dr. Elizabeth Blackwell. 

Elizabeth Blackwell was born in Bristol, England in 1821. She immigrated with her family of eleven to New York when she was eleven-years-old⁷. She was the daughter of progressive Quakers; her father, Samuel Blackwell, was an abolitionist who moved his family to several big cities across the country and advocated for rights such as freeing African Americans. Unfortunately, Samuel died when Elizabeth was seventeen years old, leaving the family impoverished. To keep her family afloat, Elizabeth, her mother, and two of her sisters began teaching and opened their own private school: The Cincinnati English and French Academy for Young Ladies⁸. 

Family portrait of the Blackwell family from Schlesinger Library, Harvard Radcliffe Institute

Elizabeth Blackwell had the spirit of her father, and desired to break societal norms. After years of teaching, she became interested in medicine while having a conversation with a terminally ill friend of hers. Her friend confided in Blackwell that she believed that if she could have received care from a woman instead of a man that her quality of care would have been far greater and her health would be much better. This conversation sparked something in Blackwell, and she became more curious about the medical world. She was particularly interested in the negative effects of doctors not washing their hands before performing procedures⁹. With this newfound curiosity, Blackwell decided to break free of her traditional societal roles and pursue a formal education in medicine¹º.

Blackwell applied to over 10 medical schools with no avail. She was even advised to disguise herself as a man in order to gain acceptance, but she refused the blasphemy and persisted on. She eventually got her foot in the door when the admission group at Geneva Medical School thought her application to be a joke and egged it on. During her years of schooling at Geneva, Blackwell faced harsh criticism. She was not allowed to attend labs, was forced to sit separately from her male classmates in lectures. This judgement did not end when she left the doors of Geneva; at every turn in town someone was there telling her just how wrong it was for her to attend medical school and how she should stick to being a woman¹¹. Despite all of this, she gradually gained the favor of her peers and graduated first in her class in 1849, becoming the first woman in America to earn a medical degree. 

Admission ticket for lectures and dissection rooms from Geneva Medical College

Unfortunately, Blackwell’s struggle did not end at graduation. For years she continued to face prejudice and was unable to find a job that would allow a female doctor to practice. Even long after her father had passed, Blackwell still carried his fighting spirit for moral justice. After twelve long years of searching for a job that would allow a woman to practice medicine, she eventually found work caring for union soldiers during the Civil War. After her time on the battlefield, she moved around New England and eventually settled back in New York; there she set up shop and found purpose tending to underprivileged people in the very city that initially accepted her as an immigrant years ago. 

Despite the trials and tribulations that she faced, Dr. Blackwell set the stage for what would soon become a prosperous career path for many women, including her own sister, Emily Blackwell¹².  Not only did she fight for gender representation in healthcare, she fought for the rights of women to learn and gain an education just as men can. Today we can thank Elizabeth Blackwell for setting the stage for women of all ages to pursue a career in STEM. Blackwell made great strides for all American women, and she also set the stage for an even more revolutionary thought: African American women in prominent healthcare positions.

References

  1. Johnson, Megan. “A Majority of Younger Physicians Are Female.” Athena Health, 14 Feb. 2018, www.athenahealth.com/knowledge-hub/practice-management/healthcare-future-female#:%7E:text=The%20healthcare%20future%20is%20female&text=From%20January%20to%20June%202017,under%2040%20percent%20are%20male. 
  2. Robertson, Lauren, and Susan Walters Schmid. “Florida: Laws and Rules of Nursing.” ATrain Education, www.atrainceu.com/node/1763. Accessed 26 Oct. 2020.
  3. “A Brief Look at the History of Nursing.” Advent Health University Online, https://online.ahu.edu/blog/brief-look-history-nursing/#:~:text=In%20the%201800’s%2C%20nursing%20began,now%20fulfilled%20by%20academic%20institutions. Accessed 28 Oct. 2020.
  4. Passmore, Susan. “A Timeline of Nursing Education.” The Sentinel Watch, 5 Mar. 2020, www.americansentinel.edu/blog/2016/09/06/a-timeline-of-nursing-education/#:%7E:text=1873%2D1889%3A%20The%20Bellevue%20Hospital,features%20a%20one%2Dyear%20program. 
  5. Wikipedia contributors. “Florence Nightingale Faculty of Nursing and Midwifery.” Wikipedia, 13 Jan. 2021, https://en.wikipedia.org/wiki/Florence_Nightingale_Faculty_of_Nursing_and_Midwifery. 
  6. Nightingale, Florence. “Florence Nightingale’s Letter of Advice to Bellevue.” JSTOR, Lippincott Williams & Wilkins, Feb. 1911, www.jstor.org/stable/3404989?seq=1#metadata_info_tab_contents. 
  7. The Editors of Encyclopaedia Britannica. “Elizabeth Blackwell British American Physician.” Encyclopedia Britannica, 30 Jan. 2021, www.britannica.com/biography/Elizabeth-Blackwell. 
  8. Famous Scientists. “Elizabeth Blackwell – Biography, Facts and Pictures.” Famous Scientists, 15 Aug. 2018, www.famousscientists.org/elizabeth-blackwell/#:%7E:text=Just%20a%20few%20weeks%20after,French%20Academy%20for%20Young%20Ladies. 
  9. Michaels, Debra. “Elizabeth Blackwell.” National Women’s History Museum, 2015, www.womenshistory.org/education-resources/biographies/elizabeth-blackwell. 
  10. Weiner, Stacy. “Celebrating 10 Women Medical Pioneers.” National Women’s History Museum, 3 Mar. 2020, www.aamc.org/news-insights/celebrating-10-women-medical-pioneers#:%7E:text=Elizabeth%20Blackwell%2C%20MD%20(1821%2D1910)%3A%20A%20fabulous%20first&text=In%201849%2C%20Elizabeth%20Blackwell%20became,care%20from%20a%20female%20doctor.n. 
  11. Ruth, Janice E. “Letter, Elizabeth Blackwell to Baroness Anne Isabella Milbanke Byron Concerning Women’s Rights and the Education of Women Physicians, 4 March 1851.” American Memory, https://memory.loc.gov/cgi-bin/query/r?ammem/mcc:@field(DOCID+@lit(mcc/065)). Accessed 13 Oct. 2020.
  12. The Editors of Encyclopaedia Britannica. “Elizabeth Blackwell | Biography & Facts.” Encyclopedia Britannica, 30 Jan. 2021, www.britannica.com/biography/Elizabeth-Blackwell. 

A glimpse at the woman behind the microscope: Mary Bruce

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Mary standing with her husband, David Brucea.

It’s hot. The air inside is stuffy, and the atmosphere is dull and heavy.  The sound of muffled groans, moans, and sniffles can be heard through the flaps of a medical tent.  As you enter the path is immediately impeded by cots holding men.  They had been crammed into an improbably small space.  Too few nurses circulate among the beds, doing their best to comfort the distressed soldiers and the occasional civilian.  Standing in a quiet corner scribbling in a notebook is Mary Bruce, everyone’s go-to. Mary is head of the Operating Theater9, and her husband, Colonel6 David, is a Royal Army Surgeon.  

In the late 1890’s Mary and David tested their newly minted marriage to serve in the Second Boer war as medic7, but the story of their scientific partnership and surprisingly modern marriage started far before the world-famous Siege of Ladysmith.  

The late 1800s was no place for a woman trying to make her mark in society.  Mary Elizabeth Steele Bruce was the wife of microbiologist Sir David Bruce, with whom she worked alongside as they traveled the world conducting research and contributing to science in a number of ways.  Sir David Bruce, as a scientist and physician, was credited with multiple fundamental discoveries in tropical medicine throughout his career. Mary Bruce, though a woman, was instrumental to David’s success, assisting him in all of his work and research. She did everything from simple note taking, to scientific illustration, to being a key contributor to published papers.   David was known for saying that he always wanted to make sure that his wife got the credit that she deserved2. It is time she was recognized and accredited for her role in tropical medicine history.    

While the specifics aren’t known, Mary Bruce received some type of education, growing up as she did in a well-to-do family.  Her younger years were during a turning point in history.  Girls were only expected to marry their husband and be a “wife”, which meant that they needed to have skills such as piano playing, flower arranging, painting, or singing. There is no record that Mary Bruce went to university, but her scientific knowledge could have easily been obtained around her home.  Her father, being a doctor9, likely had science and medical books around for Mary to sneak off with.  It is possible that her father taught her.  Even her brother turned out to be a doctor, so maybe science was just in her blood.  David was exactly the same way, which is precisely why the two were a perfect match. The couple met when David was working for Mary’s father at his family practice in Reigate, Surrey, England7. 

Mary and David’s life together was happy and full, but the two never had children, an unusual occurrence for the time period.  Not having children meant their work was unhindered by family responsibilities, enabling them to travel together with relative ease.  Mary was not considered a girly girl.  She was said to be a great shot, and never worried about her appearance, even chopping her hair short2.  She was his constant companion and worked as his technician in the lab, which is when she created many of the illustrations of his microscope work9.  Mary defied the times by traveling with the men instead of staying safely at home2.  Some said that Mary was always the one to keep David level headed; one colleague stating, “She certainly curbed his intransigence and his impatience.”7 David’s work for the Royal Army sent them to Malta, Germany, and all over sub-Saharan and South Africa.  They traveled by horse, and train and even on foot when necessary.  Each country presented a new challenge. Sometimes, their roles were doctor and nurse; other times their roles were scientific collaborators. 

Mary (back left) sitting with David (front center) and other colleaguesa.

Early in David’s career he worked for the military field service7.  The couple moved to Umbombo Hill where they were assigned to investigate an illness that was a highly prominent disease running rampant through cattle and horses of the area, however their timing and location caused them to be swept up into the chaos of the Second Boer War7.  Being able to help, they worked tirelessly to take care of wounded and sick soldiers.  Mary was Sister in Charge of The Operating Theater, or head nurse, while her husband was the operating surgeon in a field hospital he ran during the Siege of Ladysmith7.  Mary and David’s effort in the medical tents was no easy task however.  Both lost significant amounts of weight due to strict rationing, the long hours of work, and the ravages of disease.  From a letter originally destined for her sister, Mary wrote that David was in charge of 1000 patients and had worked 30 hours straight in surgery until relief was finally sent.  She reported her weight went down “7lb and 1 stone” (around 21 lbs)1. Their work did not go unnoticed, however, because David was promoted to Major-General and seconded to the Royal Society Commission which was located in Uganda around 19038.  Later on in their life, the pair was again called to service during World War I.  David’s role became Commandant of the Royal Army Medical College, though it is said that he would have preferred to be in active service.  Despite this he was knighted in 19086.  Simultaneously Mary worked on Committees focused on control of trench fever and tetanus, for which she was awarded the Order of the British Empire8.

Apart from his wartime efforts, and during the larger part of his scientific life, David Bruce was responsible for identifying the bacteria that caused of undulant fever (Micrococcus melitensis aka Brucellosis) and establishing that the parasites that cause Sleeping Sickness and the cattle wasting disease nagana, are both carried by the tsetse fly5.  Both of these pathogens (Brucella (Micrococcus) melitensis and Trypanosoma brucei) both were named after Sir David Bruce to honor his scientific work.  Along with these major discoveries, David was renowned in the UK and amongst his colleagues all over the world for his service in the Royal Army throughout his life, including his service as an educator and leader at the Royal Army Medical College8 during WWI, and his Chairmanship of the Mediterranean Fever Commission6.  David Bruce did so much with his life, but where was Mary during it all?  Though her contributions are harder to track, Mary was a vital part of the many scientific discoveries made by David Bruce.  

Mary (right) working behind the microscope in the laboratorya.

Mary Bruce held the title “Lady” because of her and her husband’s honors.  When David Bruce earned the title of “Sir”, it was customary to call the wives “Lady”4, however “Lady Bruce” was so dubbed with an “Order of the British Empire” around the time of WWI8, and this was because of her own scientific impact; not only on the WWI committee, but because they recognized her as a true woman of knowledge. She was a talented artist and illustrated most of the microscope images that can be seen in her husband’s published works, implying that she was actively working at the microscope.  In some papers, she is formally credited for the illustrations. In others’, only her M.E.B signature can be seen; but in some, she is uncredited, yet her distinctive artistic stamp is readily apparent in the elegant drawings.  Starting around 1913, Mary began to receive authorial recognition on her husband’s published papers, a time when the couple was working on human Sleeping Sickness. According to one account, Mary was also part of the actual discovery that tsetse flies were the specific carriers for the sleeping sickness trypanosome3.  Beyond this she was sacrificial with her time, as no task was too minuscule for her.  This was seen in the lab, when David asked her to dissect another 10,000 tsetse flies,  as well as in the hospital setting where she would do any menial job to relieve the strain of another.  

David’s many successes were in full partnership with his smart and talented wife, who was always working by his side. Therefore, we cannot consider his many discoveries and accomplishments without also considering Mary and her many contributions to those very same discoveries and accomplishments. Though Mary may never have felt the appreciation of her work by her colleagues that she would have in today’s age, recognition for her life’s work in scientific discovery can be acknowledged now. In a tragic but romantic twist to their unconventional story of love and science, Mary and David’s deaths were but days apart, because David could not go on without his forever love and faithful partner, Mary. Today, we can look back at the impact their work made in science and be thankful that the world was lucky to be marked by such a paramount and influential pair.  

Mary overlooking the lands of Ugandaa.

Work Cited

  1. Bruce, Mary. Letter to Dr. Russell Steele. 7 May 1900. Personal Collection J R Army Med Corps.
  2. Grogono, Basil. “Sir David and Lady Bruce. Part 1: A superb combination in the elucidation and prevention of devastating diseases.” Journal of medical biography, vol. 3 no. 2, 1995, pp. 79-83. 
  3. Grogono, Basil. “Sir David and Lady Bruce. Part 2: Further adventures and triumphs.” Journal of medical biography, vol. 3 no. 3, 1995, pp. 125-132. 
  4. Guest submission. “A Guide to the Order of the British Empire.” Royal Central, 14 Dec. 2019, royalcentral.co.uk/features/insight/a-guide-to-the-order-of-the-british-empire-21224/.
  5. kreitano. “A3: David Bruce.” General Microbiology, 23 Jan. 2018, microbiology.community.uaf.edu/2018/01/22/david-bruce/.
  6. London School of Hygiene & Tropical Medicine. “Sir David Bruce (1855-1931).” LSHTM, 2019, http://www.lshtm.ac.uk/aboutus/introducing/history/frieze/sir-david-bruce.
  7. Smyth, Alisdair James. “Lady Mary Elizabeth Steele.” geni_family_tree, 7 Oct. 2019, http://www.geni.com/people/Lady-Mary-Elizabeth-Steele/6000000024564396846. 
  8. Vol, et al. Proceedings of the Royal Society of Medicine Section of the History of Medicine Wives of some Famous Doctors PRESIDENT’S ADDRESS. , 1959.
  9. Vella, E. E. “Major-General Sir David Bruce, K.C.B.” Journal of the Royal Army Medical Corps, vol. 119, no. 3, 1973a, pp. 131-144. CrossRef, http://dx.doi.org/10.1136/jramc-119-03-02, doi:10.1136/jramc-119-03-02.

Image Sources

a. All images are in public domain.