Media versus medicine: the battle for authority on modern motherhood

In June 1914, stories extolling the wonders of twilight sleep began appearing in American periodicals, with a McClure’s article titled ‘Painless Childbirth’ by Marguerite Tracy and Constance Leupp leading the charge. As a later McClure’s piece puts it, ‘[n]o article ever published in McClure’s attracted more attention’ (Boyd and Tracy 1914, 56). In addition to providing information about the procedure, the magazine also published first-person accounts by women who had given birth under twilight sleep. Rosalind Burton Blades, for example, proclaimed that the ‘blessed rescue’ of twilight sleep ‘seemed unbelievable, a fairy tale somehow magically come true’ (Burton Blades and Burton Blades 1922, 69). Twilight sleep rapidly gained a high profile in the USA in the wake of these stories.7 As Zoe Beckley recalls in a 1922 McClure’s retrospect on the 1914 fervour, ‘news of this magic-with-the-lovely-name spread like wildfire. […] “Twilight Sleep” was on every tongue’ (Beckley 1922, 52).

The obstetric pain-management drug and procedure that would become famous as ‘twilight sleep’ had been developed during the first decade of the twentieth century in Freiburg, Germany (Cartwright 2018). A combination of scopolamine and morphine, the drug was injected at regular intervals during labour (Cartwright 2018). Judith Walzer Leavitt notes that because existing pain management techniques at the time were not always effective, twilight sleep seemed to offer a panacea: ‘the women went to sleep, delivered their babies, and woke up feeling vigorous’ (Leavitt 1980, 149). However, rather than completely eliminating pain, twilight sleep caused women to forget any pain they experienced during childbirth: Leavitt describes how ‘observers witnessed women screaming in pain during contractions, thrashing about, and giving all the outward signs of “acute suffering”,’ even though they would later have no memory of it (Leavitt 1980, 149). American physicians were particularly sceptical. In Amy H. Hairston’s analysis of the medical community’s responses, she notes that the ‘[r]eaction to the McClure’s article on ‘Painless Childbirth’ was immediate and stormy. Physicians nationwide responded angrily to what they perceived as a direct challenge to their medical authority’ (Hairston 1996, 493). Concerns about medical authority emerged from the era’s rapidly evolving medical-professional landscape. As historians Paul Starr and Nancy Tomes recount, medical associations were pursuing more ‘standardised’ regulations around ‘medical education and licensure’ as part of an effort to ‘gain a competitive edge’ in the health field (Starr 2017, 22; Tomes 2016, 26).8 John C. Burnham similarly notes that between the 1880s and 1930s, ‘institutional changes crystallized modern versions of specialization, public health, and state licensing’; he suggests that the move towards medical specialties (such as obstetrics) also played into a desire for recognised authority, since ‘specialisation’ meant ‘identifying with the scientific disciplines that increasingly constituted medical knowledge’ (Burnham 2015, 138/139). Regardless of their motivations, American doctors’ reluctance to adopt the new obstetric procedure led to public frustration and the development of the Twilight Sleep Association, which advocated for wider access (Cartwright 2018; Leavitt 1980).

Alongside twilight sleep’s rise in popularity in the mid-1910s, childbirth was becoming an increasingly medicalised process, and women faced new options when it came to prenatal care, medical interventions during childbirth and pain management strategies (Leavitt 1986; Leavitt 1999; Mitchinson 2002; Wolf 2009). As Rima Apple and Molly Ladd-Taylor argue, within this rapidly evolving sociotechnical context, women were increasingly expected to adhere to the ideals of ‘scientific motherhood’, which involved seeking out and meticulously following the advice of medical experts (Apple 2006, 2; Ladd-Taylor 1994, 4). As a paradoxical result, although women were more frequently deferring to (predominantly) male medical practitioners, many were also gaining their own medical expertise about pregnancy and childbirth9—they, therefore, saw new possibilities for claiming authority and asserting agency in these domains. As Johnson and Quinlan have argued, many women who were part of the twilight sleep movement became highly proficient in using technical and medical terminology, and in fact were often more knowledgeable about the procedure than physicians themselves (Johnson and Quinlan 2015). Leavitt argues that while we might view giving birth under twilight sleep as a loss of agency, for many women in the early twentieth century, it stood for the exact opposite: in choosing to undergo the procedure, women ‘were not succumbing to physicians or technology but were, they thought, demanding the right to control their own birthing experiences’ (Leavitt 1980, 161).10 In the twilight sleep movement, then, science and medical technology were seen by some members of the public as the key to the future of women’s rights.

Part of why twilight sleep proponents saw McClure’s as a suitable venue for promoting the procedure could be attributed to the magazine’s history of activist engagement: it ‘achieved distinction and national fame at the turn of the century by launching the “muckraking” era in American journalism’ (McClure’s Magazine 1900-1910 n.d). Reputed for exploring controversial topics, during the early years of its publication, McClure’s had published ‘exposés of abuse and corruption in American government and big business’ (McClure’s Magazine 1900-1910 n.d). For women readers, part of the magazine’s appeal was its willingness to serve as a forum for discussion on current (at times controversial) developments in women’s health–as seen in Richardson’s articles about the cost of obstetric care and the health benefits of better babies competitions; or in a piece by Anna Strunksy Walling that promoted birth control in cases where women were at increased health risks during pregnancy (Walling 1916). Both writers were also interested in twilight sleep: Richardson was involved in lecture tours promoting the procedure, while Walling published an article explicitly focused on the procedure (Walling 1922), illustrating how writers involved in the latter movement were often more broadly concerned with publicising issues related to women’s reproductive health and women’s rights.

Of particular interest to our exploration of McClure’s twilight sleep coverage is the fact that, across various critiques throughout the 1910s and 1920s, authors often articulate their discomfort with the procedure in terms of the rhetoric surrounding its promotion in popular press venues. They condemn media coverage as ‘propaganda’ (America 1916, 523), or as an attempt at ‘the latest appeal to nervous and idle women’ (Current Opinion (1913-1925) 1914, 185)⇓; they declare twilight sleep to be merely ‘[o]ne of our latest social fads in childbirth’ (O’Malley 1915, 193); and, they describe media coverage of twilight sleep as ‘hysterical (in) character’ (America 1916, 523). A McClure’s writer discussing the American medical community’s negative opinion surrounding twilight sleep wryly considers how:

…the doctors of Freiburg had further injured its good name by telling the world about it. If they had only remained silent, allowing the use of scopolamine to spread secretly from physician to physician, twilight sleep would not have become outcast. Of course, countless women would have paid the price in suffering, not a few in death, but that seemed unimportant compared to the glaring fact that two German doctors had allowed themselves to be advertised. (Burton Blades and Burton Blades 1922, 71)11

Tongue-in-cheek as this statement may read, it indicates a pervasive anxiety among obstetricians about the potential for popular media to influence the field of medicine.12 This derision for press coverage of twilight sleep is apparent across articles written by American medical professionals. As a writer declares in America, ‘[r]eviewing the history of this movement in the United States, one must perforce pay tribute to the genius of the American advertising agent. He can do anything when strengthened by an invigorating draught of printer’s ink’ (America 1916, 523). McClure’s in particular is disparaged for promoting the procedure, as we see in a Current Opinion article that singles out the publication: ‘[p]hysicians and medical journals generally find it difficult to comprehend both the claims made for the “twilight sleep” that is said to render childbirth painless and the manner in which those claims have been set forth, notably in McClure’s Magazine’ (⇓Current Opinion (1913-1925) 1914, 185). In another article, O’Malley, who was praised in America for calling out the ‘hysterical’ nature of twilight sleep ‘propaganda,’ includes McClure’s (alongside the Ladies’ Home Journal, the Cosmopolitan, and the Metropolitan) in a list of women’s publications to blame for ‘reviv(ing)’ interest in twilight sleep in the United States through media ‘exploitation’ (O’Malley 1915, 193).

In many senses, McClure’s writers exacerbated these concerns. They did see themselves as having the ability to sway public opinion on medical matters–from their perspective, however, media prowess allowed them to enact necessary healthcare reforms. In “Safety First for Mother,” Richardson argues that ‘when the lay press takes up a needed health reform, and hammers it across every breakfast-table, every supper-table, in the land, the reform is worked’ (Richardson 1915, 99). A key example of this dynamic, for Richardson, is found in press coverage of early better babies competitions and their potential health benefits. After one ‘magazine for women heard about it,’ she notes, other editors ‘published news items, special stories, accounts of contests, and editorials on the subject of better babies for America,’ and before long ‘[m]ore than one tenth of the population of America was reading and talking on this one subject’ (Richardson 1915, 99). For Richardson, this ability to influence the public was proof that the writers of magazine articles could have even greater beneficial impacts on the health of American mothers than did medical practitioners: ‘[w]hat the finest body of medical men could not accomplish through their medical literature and private practice, the lay press of the United States did–and that was to awaken the maternal conscience to the right of the child to good health’ (Richardson 1915, 99).13 Richardson’s example shows that McClure’s writers envisioned the magazine as a powerful venue for encouraging American women to embrace emerging scientific theories about motherhood–regardless of those theories’ medical endorsement.

This constellation of perspectives set the stage for the conflict between, on the one hand, the American medical community’s reluctance to embrace the controversial twilight sleep procedure, and on the other, fervent support from members of the public who worked in collaboration with popular media venues during the 1910s and 1920s. Much of the debate over twilight sleep occurred in magazines like McClure’s, and while medical professionals expressed contempt for the media attention the procedure received, media writers saw themselves as having both the ability and the responsibility to engage with the public on matters of maternal health. Because of this focus on public communication about twilight sleep, the rhetorical and visual strategies employed by McClure’s merit sustained analysis; they reveal how the framing of twilight sleep drew on (and intersected with) concurrent developments in the fields of public health, obstetrics, and eugenics.

Twilight sleep and eugenics: parallel appeals and shared audiences

At the same time that women were mobilising popular media to promote access to twilight sleep, another movement based in similar appeals to scientific authority–and wielding important implications for conceptions of modern motherhood–was emerging: positive eugenics. As a counterpart to negative eugenics, with its aims of suppressing reproduction among groups considered to be ‘inferior,’ positive eugenics refers to population control through promoting reproduction among those considered to have ‘good heredity’ (Maxwell 2008, 1). In North America, positive eugenics focused on promoting marriage and reproduction, often ‘target(ing) married middle- to upper-class Anglo-Saxon Protestants’ (Neejer 2016, 346). While the movement was often portrayed as having ‘positive’ social, health, and economic benefits, as Alexandra Minna Stern points out, this ‘distinction’ between positive and negative eugenics falsely ‘implies that they can easily be disentangled’ (Stern 2016, 9). Maria Sophia Quine explains that ‘[e]ven in its more “positive”, reform-oriented forms, eugenics was premised on authoritarian dicta […] Eugenics was and remains a system of oppression capable of altering, limiting, and ending the life chances, experiences, and choices of people in large numbers’ (Quine 2022, 2491–2492). It is important to keep this perspective in mind as we explore eugenics’ relationship to concurrent discourses of maternal health; for this reason, we use the term ‘eugenics’ in this article rather than distinguishing between its positive and negative valences.

These contexts are especially relevant to a discussion of the women who made up the primary target audience for the maternity-oriented aspects of eugenics and the twilight sleep movement. Multiple scholars have drawn attention to the gendered history of eugenics: Susan Marie Rensing describes the emergence of both ‘eugenic feminism’ and ‘feminist eugenics’ (Rensing 2006, 12); Quine describes how questions related to women’s bodily and reproductive autonomy ‘have been the primary battlegrounds of eugenic thinking and policies from the beginning’ (Quine 2022, 2493); and Randall Hansen and Desmond King argue that ‘a complete analysis of gender’s role would have to account for the large number of middle- and upper-class women who endorsed eugenics […] as a basis for increased female autonomy’ (Hansen 2013, 14). Indeed, the widespread support for the American eugenics movement is partially attributed to the involvement of middle-class white women: as Christine Neejer explains, ‘[s]tarting in the 1910s and 1920s, eugenics ideas expanded beyond circles of elites’ to ‘middle-class professionals and reformers, especially women, who began to see the benefits of eugenics in the issues that mattered to them’ (Neejer 2016, 351). Stern argues that ‘placing gender and sexuality at the center of the analysis reconfigures the history of eugenics, demanding substantial temporal and thematic revisions and delineating a story that is at once more ordinary and more complex’ (Stern 2016, 7). By centring gender, we gain insight into how twilight sleep intersected with eugenics, and how these movements gained traction and support among white, middle- and upper-class American women as they sought to redefine and navigate modern motherhood.

Notably, the eugenics arguments directed at women functioned similarly to those based on the twilight sleep movement with their appeal to women’s desire for scientific authority and medical agency. As Natalie Oveyssi argues, the benefits women saw for themselves in eugenics have often been overlooked: ‘[w]hile scholars have portrayed eugenics as simply a tactic to coerce and subjugate women’s sexuality and fertility […] some middle-class white women supported eugenics because of its promises for self-empowerment’ (Oveyssi 2015, 1). Rensing describes how Elizabeth Cady Stanton, a women’s rights activist, embraced eugenics because it gave credibility to her arguments by drawing on contemporary scientific authority: she ‘arm(ed) herself with eugenics in a concerted attempt to outflank women’s rights opponents by fighting science with science’ (Rensing 2006, 15). These perspectives implicitly echo arguments that position women’s choice to embrace twilight sleep as a science-based assertion of agency over the childbirth experience.

Eugenics was also seen as an opportunity for women to become involved in science and politics to serve national interests. For example, Edward J. Larson describes how the Southern eugenics movement allowed women ‘to participate in state politics and led to the creation of public institutions that allocated significant administrative jobs and policy positions to women’ (Larson 1995, 30). In addition to giving women opportunities to become involved in political organisations, eugenics was touted as a science-based way of improving public health14 and working against the falling birthrate among white middle and upper-class American women (Oveyssi 2015, 3). As Anne Maxwell explains, ‘[t]he idea was that once people realized how threatened the Anglo-Saxon race really was, they would produce more children out of a sense of patriotic duty’ (Maxwell 2008, 142). Overall, eugenics sought to appeal to American women by promising them a way to contribute to society as ‘eugenic mothers’ who shaped the future of their community and country (Oveyssi 2015, 26), or, as Wendy Kline puts it, as ‘mothers of tomorrow’ who embody the ideal of ‘a progressive, forward-looking, socially responsible, moral, and civilized woman who would raise tomorrow’s children’ (Kline 2001, 16/29).

McClure’s Magazine played host to this type of argument, as illustrated in a 1917 article titled ‘More About Husbands and Better Babies’ by Cleveland Moffett. ‘Few persons realize how alarmingly the birth rate is decreasing among our best American families’, Moffett opines, before insisting that women should be willing to ‘repay’ the state for their citizenship by providing ‘motherhood service’ (Moffett 1917, 27). Connecting the eugenics argument about obligatory maternity to the ongoing battles for women’s suffrage, Moffett writes that ‘[i]n these days when women are demanding and receiving full-citizen privileges it is right and necessary that they show themselves willing to render full-citizen service. And, obviously, the greatest service women can render to the State is to produce desirable future citizens’ (Moffett 1917, 26). By presenting this argument in a magazine known for its willingness to explore controversial developments in reproductive health, Moffett offers an enticing appeal to McClure’s readers–readers who seek acknowledgement as intelligent citizens with the ability to cultivate and improve their communities and nation.

Other McClure’s writers similarly drew attention to falling birthrates and proposed twilight sleep as a means to overcome fear of labour that might prevent some women from having children. A 1915 article titled ‘Twilight Sleep in America’ quotes a physician, Dr Knipe, who draws on eugenicist rhetoric to argue that by addressing middle and upper-class women’s fear of childbirth, twilight sleep can rectify their falling birthrates. ‘Dammerschlaf’,15 he proposes, ‘not only has a place in obstetrics, but will also be a strong factor in lessening the number of artificially induced abortions, because there will be a lessened fear of motherhood. It is also not unreasonable to assume that there will be an increase in the number of children of the intelligent families’ (Leupp and Hendrick 1915, 36, emphasis added).16 Knipe explicitly references contemporary proponents of eugenics, describing how ‘Dammerschlaf and asepsis [may] be the great factors in the approach to the millennium which is attainable, according to the Shavian School, only through the conscious endeavor to produce the greatest number of the best offspring’ (Leupp and Hendrick 1915, 36). Piers J. Hale explains that George Bernard Shaw (originator of ‘Shavian eugenics’) had gained ‘notoriety for making out-spoken eugenic comments’ and believed in ‘the vast improvement of the human intellect’, with the outcome being ‘the evolution of a race of “supermen”’ (Hale 2006, 204). As Knipe’s reference to Shaw’s ‘outspoken’ beliefs shows, twilight sleep and eugenics were evidently connected in the minds of American physicians and McClure’s writers.

Moffett’s oblique reference to women’s suffrage also offers a connection to a broader set of interrelated social factors that influenced the communication tactics for twilight sleep promotion. Indeed, McClure’s and its protwilight sleep authors benefited from an already-existing set of social and political networks. As historians such as Hairston (1996), Ladd-Taylor (1994) and Leavitt (1980) have explained, American motherhood—and specifically, scientific motherhood—was increasingly being connected with women’s political rights and social positions at this time. Ladd-Taylor is explicit about this connection: during ‘the first years of the twentieth century’, she writes, ‘maternal and child welfare first became national political concerns’ (Ladd-Taylor 1994, 1). Her arguments focus on the ways in which ‘activist women were responsible for some of the biggest welfare accomplishments of the Progressive era’ (Ladd-Taylor 1994, 2). ‘With limited resources’, Ladd-Taylor explains, the Children’s Bureau’s first chief, Julia Lathrop ‘used her extensive contacts among members of women’s clubs, college-educated women, social workers, and scholars to mobilize community support for child-welfare work’ (Ladd-Taylor 1986, 8).

The twilight sleep movement emerged, in many ways, in the shadow of the Bureau’s early projects, and also in tandem with ideals that aligned with the women’s suffrage movement. Lauren MacIvor Thompson describes how proponents of twilight sleep believed that ‘eliminating female reproductive pain and suffering […] had the radical potential to establish a new political order in which women were incorporated as equals’ (MacIvor Thompson 2019, 68), and Hairston argues that women’s suffrage created the foundation for the emerging movement, since ‘by the early summer of 1914, American women had extensive experience in organizing and maintaining a massive national campaign’ (Hairston 1996, 490). Thanks to these existing organisational networks, the women involved in promoting twilight sleep had ‘access to growing membership, a message to incite action, their own publishing companies, financial support, and a flair for dramatic presentation of their cause to print media’ (Hairston 1996, 490). Furthermore, the women who were reading McClure’s were also often socially connected. Hairston notes that ‘[m]any women subscribers to McClure’s and similar magazines already belonged to women’s clubs, which provided the structure and focus that made twilight sleep a natural cause to support’ (Hairston 1996, 495). McClure’s was, therefore, able to gain momentum in its promotion of twilight sleep precisely because of the sociopolitical networks established by earlier suffrage activists and federal public servants. Women working across these networks strategically mobilised media communication channels; more specifically, they sought to capture readers’ attention by capitalising on the multimodal–that is, combined textual and visual–rhetorical strategies available to them.

Our exploration of these strategies builds on Maxwell’s insightful analysis of the way that eugenicists made ‘extensive use of photography to promote eugenics in both the public and intellectual spheres’ (Maxwell 2008, 1). As Maxwell explains,

…the eclectic nature of their images reflects the duality of the movement; on the one hand, photographs of beautiful babies and attractive Aryan men and women played a role in encouraging those of good heredity to breed (positive eugenics), while photographs of criminals and the mentally ill served to gain support for limiting or preventing those of inferior heredity from reproducing (negative eugenics). (Maxwell 2008, 1)

Visual portrayals of ‘good heredity’ were thus seen as providing a form of ‘evidence’ to support eugenics’ discriminatory reproductive policies and prescriptive public health campaigns. Maxwell explores how eugenicists drew on realistic ‘social documentary photography’ techniques, which were used ‘to drum up support for eugenic solutions to complex social problems’ by divulging the poor material living conditions of lower-class Americans (Maxwell 2008, 13). In addition, she traces how social documentary photography worked in tandem with more narratively oriented ‘photojournalism’ practices, where a series of photographs accompanied by captions are designed to convey a compelling story that will reach a wide audience (Maxwell 2008, 14). The latter, she explains, ‘became just as useful as documentary photography for fostering strong opinions and prejudices, since pictures were more apt to appeal to the emotions than the written word, particularly when accompanied by a caption or text that dictated the meaning’ (Maxwell 2008, 14).

The pair of drawings that appear in Moffett’s 1917 article are clearly designed with these strategies in mind (figure 1). His written argument is clear: that not all women are fulfilling their ‘motherhood service’, and that the ‘birth-burden must be borne equally by all married women and must not, as at present, be placed excessively upon a portion of the women, while another portion evade this duty’ (Moffett 1917, 26). Importantly, the accompanying illustrations bolster these propositions by fulfilling precisely the types of documentary and journalistic roles Maxwell identifies. One depicts a young, glamorous-looking woman lounging alone on a couch in a comfortably furnished room, and a second depicts a tired-looking older woman doing laundry while surrounded by six small children. The captions read: ‘[i]s it fair that this wealthy woman should bear no children, while—/—this woman, who is poor and a drudge, must bear more than her share?’ (Moffett 1917, 27). These paired images and captions weave a compelling narrative: by emphasising the differences in the lives of wealthy and poor American women, they criticise upper-class women (the so-called genetically ‘fit’) for shirking their patriotic duty and attempt to awaken them to the urgency of embracing motherhood rather than leaving the future of American society in the hands of (eugenically inferior) ‘drudges’.

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Figure 1

Two illustrations by Willard Fairchild that appeared in a June 1917 McClure’s article by Cleveland Moffett, ‘More About Husbands and Better Children’. Source: Internet Archive: https://archive.org/details/sim_new-mcclures-magazine_1917-06_49_2/page/26/mode/2up?view=theater.

Twilight sleep and the glamorous ideal of the modern eugenic mother

To state that McClure’s and other periodicals from the early twentieth century employed carefully curated visual images to craft an idealised version of the ‘modern woman’, and that this woman represented a glamorous vision of femininity to middle and upper-class target audiences, is perhaps fairly obvious. After all, even a quick glance through the archive of McClure’s covers (figure 2) confirms an emphasis on youth, fashion and affluence: images feature young women wearing stylish clothing, often adorned with jewellery, hats and gloves, and occasionally holding objects like flowers, riding crops and teacups. Importantly, though, this visual ideal of the glamorous modern woman was also connected, within the pages of those issues, to intelligence, health and maternity. The June 1914 issue, the cover of which features an illustration of a poised and well-dressed young woman, also contains Tracy and Leupp’s (in)famous article introducing McClure’s readers to twilight sleep. The May 1915 issue, with its cover image’s depiction of a young couple dancing in formal clothing, also prints Richardson’s ‘Safety First for Mother’ piece. And the March 1923 issue, which presents on its cover another well-dressed young woman, this time wearing pearls, is where Hale’s discussion of lecturing on the benefits of twilight sleep with Richardson appears. These McClure’s covers do not simply frame the magazine content as being relevant to young, fashionable and affluent ‘modern women’; they also invite us to see how a visually glamorous ideal can serve as a starting point for a more complex rhetorical argument about the appeal of medical agency and scientific motherhood for the modern woman.

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Figure 2

From left to right: the June 1914, May 1915 and March 1923 covers of McClure’s Magazine. Illustrations by Clarence F. Underwood (June 1914 and May 1915) and Earl Christy (March 1923). Source: Internet Archive.

Like McClure’s target readers, a frequent primary audience for (positive) eugenics was wealthy, middle and upper-class women. While eugenics’ goals were not always connected with wealth and glamour, these associations are apparent in the movement’s attempt ‘to influence white middle-class womanhood by promoting motherhood for the benefit of the race’ (Kline 2001, 30). Indeed, as Oveyssi puts it, ‘[t]he “modern woman” became an ideal for young middle-class women’ (Oveyssi 2015, 11). Within popular media, they:

…were portrayed as forward-thinking trailblazers, whom female readers could follow or risk being left in the dust of antiquity. … [N]ewspapers recorded these women’s thoughts for mass distribution to an interested public. For young women trying to establish a space for themselves in their changing societies, these eugenic women would have been powerful role models of modern womanhood. Most influentially, these eugenic women were intellectually and behaviorally independent and even rebellious. (Oveyssi 2015, 13)

This association with intellectual independence and rebellious agency often meant that the ‘ideal’ eugenicist woman was knowledgeable about current developments in science, medicine, and women’s health. Oveyssi explains that ‘[e]ugenics was well-represented in the popular trend of “parlor science”, a combination of education and entertainment that typically took place in the home’, where ‘[w]omen’s clubs often […] invited professors, researchers, and doctors to give lectures on popular topics, including eugenics’ (Oveyssi 2015, 36). A central purpose of these events was to court these groups of women and solidify their buy-in and ‘cooperation’ with the eugenic project (Oveyssi 2015, 3). As an enticing complement to these more intellectual activities, the movement also used magazines to depict the ideal eugenic woman as physically attractive and impressive. As Oveyssi outlines, ‘eugenic women’ (Oveyssi 2015, 13) were frequently described in magazine profiles as attractive, athletic, independent, creative, intellectual members of the American middle class. As an example, she describes the profile of Violette Wilson, ‘an athlete who had played as the only woman on her high school’s football team and who had hiked 300 miles in the Sierra Nevada wearing men’s clothes’ (Oveyssi 2015, 13). This athleticism is combined with Wilson’s interest in reading work by feminist writers; as a result, ‘[a]s a modern, independent, and intelligent young woman knowledgeable about eugenics, Wilson exemplified the archetype of the eugenic woman’ (Oveyssi 2015, 13). This specific description offers a bridge to understanding the significance of how twilight sleep advocates writing for public magazines like McClure’s presented mothers who had undergone the procedure.

Perhaps the equivalent ‘archetype of the [twilight sleep] woman’ is found in Rosalind Burton Blades; her combined textual and visual depiction in the McClure’s article, ‘Twilight Sleep in America’, (which she coauthored with her husband, Leslie) exhibits an uncanny resemblance to the vision of Violette Wilson’s modern, eugenic femininity. As the daughter of two physicians, Rosalind had access to cutting edge medical information, and was encouraged to consider twilight sleep by her mother. Rosalind recounts how her mother had written her a letter about twilight sleep during Rosalind’s first pregnancy, stating (in an echo of typical American medical perspectives of the day) that ‘[y]our father […] is opposed to the use of scopolamine. The medical journals are against it and there are many dubious things about it’ (Burton Blades and Burton Blades 1922, 68). Later, however, Rosalind’s mother describes her decision to try administering twilight sleep and her ensuing enthusiasm (Burton Blades and Burton Blades 1922, 69). Rosalind proceeds to give birth under twilight sleep. In this representation, the fact that she pursues a controversial and cutting-edge medical treatment at her mother’s advice, even despite the initial wariness of her physician father and the medical community in general, situates Rosalind among the rebellious, independent, medically avant-garde women of the early twentieth century.

In the second half of the article (penned by her husband), text and image come together to solidify Rosalind’s status among this elite group thanks to both her physical and intellectual prowess. Leslie recalls how only 4 days after giving birth, and ‘in spite of the doctors’ protests’, Rosalind ‘was up and moving about the house without the slightest inconvenience’ (Burton Blades and Burton Blades 1922, 71). This description of Rosalind’s fitness and energy after her experience with twilight sleep is affirmed with a photograph of Rosalind holding her infant son Roland (figure 3); the caption proclaims that, a mere 2 weeks after birth, the mother-son duo ‘had already taken a transcontinental trip’ (Burton Blades and Burton Blades 1922, 72). Although the postpartum mother is more modestly clothed than her McClure’s cover-girl counterparts, Rosalind appears equally poised, confidently displaying her upright body–and her peacefully dozing baby–for viewers’ scrutiny and approval. As Leslie recounts, Rosalind continues to rapidly regain her physical strength, and she doesn’t let motherhood deter her from her academic ambitions: ‘[i]n September my wife went back to college where she was that year a sophomore, and during that term she filled her position as captain of the girl’s basketball team’ (Burton Blades and Burton Blades 1922, 72). After the birth of their second son, Rosalind again returns to her education–this time ‘to take her master’s degree, and as before she took full part in all college activities’ (Burton Blades and Burton Blades 1922, 72). Rosalind is thus depicted as an ideal, modern, eugenic mother. She is an athletic, educated and outgoing woman who was able to give birth to two healthy sons while also pursuing postsecondary education, taking ‘full part’ in extracurricular activities, and maintaining optimal physical fitness.

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Figure 3

A photograph showing Rosalind Burton Blades and her son, Roland, which appeared in the August 1922 McClure’s article ‘Twilight Sleep in America’. Source: Internet Archive: https://archive.org/details/sim_new-mcclures-magazine_1922-08_54_6/page/68/mode/2up.

In McClure’s depiction of Rosalind Burton Blades as a spokeswoman for twilight sleep motherhood, we can see direct connections with the modern ideals of eugenic femininity. It is important to recognise the widely circulating status of this ideal and the way it sutured twilight sleep and eugenics discourses during the 1910s; Johnson and Quinlan’s analysis of the ‘high-society framing’ of twilight sleep is particularly illuminating in this regard (Johnson and Quinlan 2017, 63). They argue that reporting in the newspaper The Brooklyn Eagle (TBE) ‘utilized [twilight sleep] as a status symbol in Brooklyn’ (Johnson and Quinlan 2017, 64) and that its ‘depiction of [twilight sleep] in late 1914 and early 1915 as the most successful new obstetric intervention at the most well-known, most advanced hospitals in Brooklyn lent [it] an air of credibility and sophistication’ (Johnson and Quinlan 2017, 65). This classist framing contributed to problematic, racially inflected assumptions about American identity and motherhood. As Johnson and Quinlan explain, since TBE ‘depicted women interested in [twilight sleep] as exemplars of gender propriety, having babies for the good of the race [, … t]hese women upheld the myth of a homogeneous, wealthy, White Brooklyn in TBE by being White and wealthy themselves’ (Johnson and Quinlan 2017, 62). It is important to remember that the depictions of twilight sleep mothers in McClure’s do similar work as they participate in a broader rhetorical project shared with the eugenics movement. Combining the visual and textual elements of popular media, they forge an implicit association between a desired social outcome (uptake of a new medical procedure/adherence to emerging public health ideals) and readers’ desires for wealth, high society and sophistication.

The picture of health: twilight sleep and the visual marketing of ‘better babies’

Alongside the images of highly educated and physically attractive twilight sleep mothers, McClure’s articles also mobilised photographic evidence to bolster an argument about the health and vitality of those mothers’ ‘twilight babies’. Rosalind’s mother’s assurances about twilight sleep’s excellent results emphasise the fact that out of all the cases in which they had used the procedure, ‘[n]ot one of the twenty-two babies showed any evil effect justifying popular fears. Within a few short hours every one of them was as healthy a wee bundle of warm animation as any mother could desire’ (Burton Blades and Burton Blades 1922, 69). Later in the piece, Leslie contrasts his neighbours’ almost ‘hostil[e]’ initial responses to Rosalind’s decision to undergo twilight sleep with their later astonishment at the healthy appearance of the couple’s infant son, Roland; one neighbour confesses ‘he is some boy, and he certainly does look healthy!’ (Burton Blades and Burton Blades 1922, 71–72). The couple decides to use twilight sleep again for the birth of their second son, Vernon, and the article implies a medical justification for their decision by making repeated reference to the physical appearance of their sons. For example, several photographs of Roland and Vernon are accompanied by descriptions extolling the boys’ health, vitality and size. Their second son ‘was even a healthier baby than his brother’; ‘[w]eighing eight and one-half pounds at birth, he promptly started in to grow, and today they are as strapping a pair of real, live lads as one could see anywhere’ (Burton Blades and Burton Blades 1922, 73). Later, Leslie writes that ‘[n]either child has ever known a single ailment, not even the lighter diseases common among children’ (Burton Blades and Burton Blades 1922, 73). He even claims that they are growing even faster and becoming taller than expected for children of their age: ‘Roland is nearing his eighth birthday, and when we buy him clothes, which is distressingly often, we buy those marked for an eleven or a twelve-year-old boy. Vernon, at five, wears eight and nine year-old suits’ (Burton Blades and Burton Blades 1922, 73). These descriptions and their accompanying photographs promote twilight sleep by casting it as a method for producing healthy children that ‘any mother could desire’.

While the Burton Blades’s article does not contain explicit references to eugenics, it nonetheless advances aligned arguments by positioning twilight sleep as a way for women to harness medical expertise and new scientific developments. The photographs are mobilised to imply a pathos-laden argument about the enhanced health of children born under twilight sleep. By incorporating medical authority along with descriptions and photographs of the healthy children to appeal to prospective mothers, this rhetorical strategy echoes those used by the eugenics movement to appeal to women as the primary decision-makers when it comes to reproduction and childcare. As this article demonstrates, the twilight sleep movement, like the eugenics movement, reinforced the importance of women’s decisions about their reproductive health by framing these decisions not just in terms of the well-being of the mother, but also in terms of the future health and physical development of their children.

Other McClure’s articles similarly sought to encourage twilight sleep use among American women and physicians by presenting photographic evidence of the procedure’s success. In the 1915 article ‘Twilight Sleep in America’, Leupp and Hendrick describe a growing interest in the United States. Despite the initially negative response from the medical community, the authors write that more American physicians have started to investigate the procedure by visiting the Freiburg clinic and experimenting with twilight sleep in their own practices–with ‘results […] of extraordinary interest’ (Leupp and Hendrick 1915, 25). One of the primary means through which these results are shown is through photographs: eight photographs of ‘twilight sleep babies’ appear throughout Leupp and Hendrick’s article, each of which takes up at least half a page (figure 4). These attention-grabbing images typically show happy and healthy-looking babies, and they are accompanied by captions outlining the safety of twilight sleep. For example, the very first is captioned, ‘[i]n the last eight months, probably three thousand Twilight Sleep babies have been born in the United States–one third as many as Freiburg had in ten years’ (Leupp and Hendrick 1915, 26). Another caption claims that while ‘critics of this method declare that it is dangerous for the child’, among the thousands of twilight sleep babies born in Germany ‘not a single death has been traced to it’ (Leupp and Hendrick 1915, 27). Similar captions proclaim the success and safety of the procedure at multiple specific hospitals. Indeed, location is regularly highlighted: in addition to the mentions of Freiburg clinic, the Long Island College Hospital, and New York City hospitals, another image caption, appearing under a photograph of a ‘five months-old Twilight Sleep baby’ (Leupp and Hendrick 1915, 31), notes that twilight sleep has been used in ‘New York, Cleveland, Chicago, Washington, St. Louis, Atlanta, San Francisco, Philadelphia, Cincinnati, Milwaukee, Baltimore, and Boston’ (Leupp and Hendrick 1915, 31). By emphasising the abundance of healthy twilight sleep babies and the widespread implementation of the procedure, these captions combine qualitative claims about the procedure’s safety with visual evidence of healthy babies.

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Figure 4

Eight photographs of ‘twilight sleep babies’ that appeared in the April 1915 McClure’s article ‘Twilight Sleep in America’ written by Constance Leupp and Burton J. Hendrick. Source: Internet Archive: https://archive.org/details/sim_new-mcclures-magazine_1915-04_44_6/page/24/mode/2up?view=theater.

The accumulating visual logic that these infant portraits bring to the article complements Leupp and Hendrick’s reliance on quantitative data to directly counter American medical scepticism. For instance, they observe that ‘[m]any important medical journals in the United States had denounced the Freiburg Twilight Sleep in almost vituperative terms’ (Leupp and Hendrick 1915, 26), but then provide laudatory statistics from Freiburg: ‘[i]n 1914 König and Gauss said, in scientific journals, that they had had nearly five thousand cases of Twilight Sleep, with eighty per cent of successes. Just consider that number of cases—five thousand!’ (Leupp and Hendrick 1915, 30). Again, images support these claims; they are even accompanied by captions quoting physicians, including Dr Knipe, who describes the ‘excellent results obtained for the mother and child’ (Leupp and Hendrick 1915, 33). These physician testimonials are used to provide evidence of the safety of twilight sleep for mothers, alongside the photographs that provide evidence of the safety of the procedure for babies.

The display of images of ‘twilight babies’ became such a popular tactic that the movement’s critics took note. Some American physicians condemned these photographs as playing an unethical role in the ‘advertising’ they believed the twilight sleep movement was using to gain support. For example, one American physician, J.H. Salisbury, wrote in a 1914 letter to the editor published in the Journal of the American Medical Association that he believed the photographs included in Mary Boyd and Marguerite Tracy’s October 1914 McClure’s article about twilight sleep were highly misrepresentative:

The article … is a good example of the fallacious arguments and pictorial intimations that are being pressed on the American public in support of this very doubtful procedure in obstetrics. Pictures of scopolamin-morphin [sic.] or Freiburg babies adorn several pages of the magazine. They generally represent children from 3 to 5 years of age as if the vigor depended on the fact that their mothers had received a sixth of a grain of morphin and an indeterminate amount of scopolamin during their birth. (Salisbury 1914, 1410)

Salisbury’s concern centres on the fact that ‘the intimation is continually presented to the reader that scopolamin-morphin has some magic far-reaching influence that changes the physical destiny of the child’ (Salisbury 1914, 1410). This letter is responding to the type of implied causality in photographs such as the portrait of a ‘Freiburg mother’ with her two children that appeared in the Boyd and Tracy article Salisbury criticised. The caption explains that the woman’s son was born ‘in the “old school” way’, and is being ‘rapidly outdistanced in physical development’ by her daughter–born under ‘scopolamin’– despite her being 2 years younger (Boyd and Tracy 1914, 65). As Salisbury’s critique illustrates, the photographs of twilight sleep babies were seen–even by physicians–as playing a significant role in the media campaign to sway public audiences towards embracing twilight sleep.

Babies on display: public exhibits of ‘twilight sleep babies’

The visual rhetoric of twilight sleep and eugenics converged in public events designed to showcase healthy infants, where the strategies used in magazines like McClure’s to promote maternal and infant health came off the page. Along with illustrations and photographs of twilight sleep mothers and babies, exhibiting actual babies born under twilight sleep was yet another visual strategy for promoting the procedure. In a 1923 McClure’s article, Ruth Hale—a woman who had given birth under twilight sleep herself—recounts her experience as a public advocate for the method. Hale explains that McClure’s wanted ‘to try to raise a fund for a central Twilight Sleep clinic in which American doctors could be taught how to use it’ (Hale 1923, 94), so she and Richardson were sent out on a ‘lecture tour of the country’ (Hale 1923, 94). Hale describes the content of their lectures, noting that

…Mrs. Richardson had made wide research, not only into the experiences of the American physicians but into those of Germany, and she had statements from many men of indisputable authority in medical work. Then, finally, we had a Twilight Sleep baby, who, thank heaven, was a good and sweet child, since Twilight Sleep, whatever its other virtues, can not make a good-tempered baby out of a natural hellion. The baby was for afternoon appearances only (Hale 1923, 94).

By combining the medical authority of physicians with the appearance of a ‘good and sweet’ baby, this appeal to scientific motherhood replicates what we see in the pages of McClure’s. The article is accompanied, unsurprisingly, by multiple photographs of Hale’s own son, who was born under twilight sleep. And yet, in spite of claims that the procedure can influence the development of children born under twilight sleep, Hale herself acknowledges that this correlation is pure chance. While healthy, ‘strapping’, and ‘sweet-tempered’ babies were used to promote the procedure both in photographs and at public exhibits, these infants serve a primarily rhetorical function to craft an image of the benefits of twilight sleep.

In a 1923 McClure’s article, Edna Purdy Walsh illuminates another site of visual-rhetoric overlap between the twilight sleep and the eugenics movements: ‘Better Babies’ and ‘Fitter Families’ competitions.17 These competitions, which gained popularity throughout the 1910s and 1920s across the USA (Selden 2005), were public events intended to allow middle-class American families to show off their children, while also educating participants on the standards against which they should measure their children’s health and development. During better babies competitions, infants were examined by medical professionals, and they received a score based on how well they met specific metrics.18 As Meghan Crnic outlines, the infants were typically compared with average measurements for children of their age and were assigned a score (Crnic 2009, 13). The winning family received a prize, which could be a medal, trophy, certificate, or cash (Crnic 2009; Selden 2005). In Walsh’s article, photographs of healthy twilight sleep babies are accompanied by the following text:

It is interesting to add that in the California town where the writer of this account lives, there are a number of Twilight babies. In a ‘better baby’ week contest in this town a few years ago, an out-of-town unprejudiced baby specialist, knowing nothing of the circumstances of the babies’ birth, ranked the babies of the town according to this schedule: 70-80, fair; 80-90, good; 90-100; excellent. They were classed by age. All Twilight babies scored over 90. The highest in each class was a Twilight baby (Walsh 1923, 100, emphasis added).

This description of a better babies competition, which attributes the babies’ high scores to the use of twilight sleep during their birth, relies on the same rhetorical strategies that conflate twilight sleep during labour with optimal physical and mental development of babies. For Walsh, the success of ‘twilight sleep babies’ is undeniable evidence of the safety and desirability of twilight sleep, since it can result in babies that score the highest rankings in competitions. The implied causality behind this claim is strengthened by a source of ‘unprejudiced’ medical expertise.

Walsh’s article reveals the reciprocal nature of the relationship between twilight sleep and eugenics’ rhetoric: rather than twilight sleep’s ability to achieve painless childbirth being used to encourage childbirth among ‘intelligent families’ (as we saw in Leupp and Hendrick’s article), the eugenics movement’s better babies competitions are here used to promote the safety of twilight sleep. Photography is, once again, a central component of the argument. Maxwell explains that ‘photographs became an integral part of the competition; they endorsed the idea that only those families who produced the largest and healthiest families would have the community’s approbation, and they promoted the role of motherhood, redefining its worth and status as vital to the nation’s successful future’ (Maxwell 2008, 142). While no photographs of better babies competitions are included in Walsh’s article, it does include multiple photographs of twilight sleep babies. For example, the headline is immediately preceded by a photograph of four children, captioned ‘Four California cousins, all twilight sleep children’ (Walsh 1923, 97) (figure 5). This photograph emphasises the potential for twilight sleep to lead to larger and healthier families–exactly what the ‘better babies’ competitions promoted.

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Figure 5

A photograph showing four cousins who were all born with Twilight Sleep, which appeared in Edna Purdy Walsh’s May 1923 McClure’s article ‘Twilight Sleep and the Baby: A Ten Years’ Record of Happy Mothers and Healthy Children’. Source: Internet Archive: https://archive.org/details/sim_new-mcclures-magazine_1923-05_55_3/page/96/mode/2up.

Returning to the themes we explored earlier in this article, the appeal of better babies competitions to proponents of twilight sleep (and vice versa) likely lay in the agency that it granted white, middle-class American mothers. Crnic explains that ‘one of the primary objectives of the contests, and likely one of the motivations for parents to participate, was to show mothers how to make their children Better Babies through systematic, scientific care’ (Crnic 2009, 14, emphasis in original). Selden similarly describes how the contests ‘serve[d] as a venue for constructing public opinion as they recommended that decisions regarding marriage and procreation be informed by eugenic interpretation’ (Selden 2005, 212). We can see this dynamic at play in the McClure’s article we opened with. Richardson’s ‘Safety First for Mother’ ends by describing the impact of better babies competitions on the health of American women and children:

As organizer of the Better Babies movement of the Woman’s Home Companion, I watched with intense interest the gradual change in the character of inquiries that came to my desk:

First, ‘How can I improve the condition of my child?’

Second: ‘How can I have the defects in my child reduced or removed?’

Third: ‘How can I prevent defects in my next baby by more intelligent care immediately after it is born?’

Fourth, and finally–the fundamental question: ‘How can I take care of myself, that I may bring a healthy child into the world?’ (Richardson 1915, 99, emphasis added).

For proponents of twilight sleep and eugenics, this final question–how a woman can gain the scientific knowledge needed to make medical decisions for herself that will benefit her child’s health and development–was a central, overlapping concern. In Walsh’s article, we can see one example of a response to this question. Twilight sleep can be framed according to the benefits it promises for children–as a tool for producing babies that score the highest rankings in eugenics-based competitions–and therefore as a medical intervention that responsible, eugenically minded mothers should embrace. As we have also seen, though, the procedure can also be cast in terms of the significant benefits it offers women, thanks to its association with the glamorous, intelligent, healthy ideal of eugenic femininity. By bringing together these varied, yet mutually reinforcing perspectives and arguments, publications like McClure’s staged a multimodal, multifaceted rhetorical appeal that fundamentally altered the discourse and practices surrounding modern maternity.

Coda: public-health eugenics and maternity media

Twilight sleep represents a significant moment in the history of obstetrics, when the public learnt about new obstetric developments not from their physicians or other medical authorities, but from lay writers in popular media like McClure’s. Our analysis demonstrates how twilight sleep advocates engaged with the discourse of the concurrently developing American eugenics movement to frame twilight sleep as a science-based approach to motherhood that could address falling birth rates among white, middle-class and upper-class, able-bodied women and improve the health and vitality of their children. McClure’s writers combined textual and visual arguments to encourage readers to identify with the ideal of glamorous, educated, independent ‘scientific mothers’. Images of healthy twilight sleep babies frequently appeared in McClure’s articles, and these images were combined with statistics, testimonials from twilight sleep parents, and claims about twilight sleep babies’ performance in better babies competitions to develop a persuasive argument for the obstetric procedure’s benefits.

While we focus on media engagement with twilight sleep in the 1910s-1920s, the visual representation of mothers, along with their babies, continues to be a core component of how maternity becomes a venue for contentious, politicised debate among public audiences. For example, antiabortion campaigns frequently employ images to elicit emotional reactions from viewers: Brian Callender et al. note that ‘[t]he ultrasound image of the fetus in utero is iconic and has transcended the medical domain into our everyday visual culture’, which raises questions such as, ‘[w]hat should medicine’s role be in creating, interpreting, and disseminating these images, particularly when the image or imaging technology is used to restrict reproductive rights and violate core principles of clinical ethics?’ (Callender et al 2021, 1208/1209). While the methods and aims of employing images in anti-abortion campaigns differ from those in the twilight sleep movement, both instances illustrate the intersections of visual rhetoric with medical, technological, social and political developments around maternity, reproductive health and women’s political and medical rights. By understanding the nuances of these visual depictions, we can better understand how conceptions of ‘modern’ maternity have shifted–and continue to develop–over time.

While the hype surrounding twilight sleep only lasted for a brief period between the mid-1910s and early 1920s, examining the media attention that the procedure received is crucial to understanding the development of modern maternity across the twentieth and into the twenty-first century. As McClure’s promotion of twilight sleep demonstrates, the procedure was framed as an appealing way to improve maternal and infant health by engaging in scientific motherhood, and it was often closely connected with the American eugenics movement. As Paul Lombardo notes, although the role of eugenics in the history of public health has often been overlooked, ‘[a] retrospective assessment of [its] legacy … suggests that caution is in order when plans are proposed for managing population health through reproductive interventions’ (Lombardo 2019, 650). As an early ‘reproductive intervention’, twilight sleep (and the discourse surrounding it) can generate valuable insights within these discussions.

As just one potential example, scholars of eugenics have called for us to recognise how its ideology continues to impact reproductive health, genetics and biomedicine in the twenty-first century. Stern describes how eugenics ‘was repackaged’ following WWII (Stern 2016, 3). This ‘repackaged’ version, as Robert A. Wilson points out, is rooted in positive eugenics, which endures, he argues, because it has historically been perceived as ‘a more acceptable form of eugenics than negative eugenics’ (Wilson 2014, 3). Wilson argues that positive eugenics continues to contribute to ‘moral problems’ (Wilson 2014, 4) in contemporary bioethics, precisely because of the lack of attention it receives. With twilight sleep discourse in mind, we can pursue nuanced responses to how the ‘repackaged’ eugenics of the twentieth century are emerging in twenty-first-century policies surrounding public health, obstetrics, and women’s health. While answers to that question are beyond the scope of this article, we hope our exploration of the visual and textual rhetorical strategies employed in the past will help future researchers better identify the ways that eugenics continues to influence women’s reproductive health, medical agency and access to healthcare today.