The Comstock Act is not fiction. All of the incidents mentioned in the story—including Anthony Comstock’s antics in and out of the courtroom—are based on the historical record, in particular on newspaper accounts.
I was especially careful about advances in medical science, because some of the most important discoveries—the nature of infection and the importance of sterile techniques, for example—were not instantaneously accepted or practiced; just the opposite. The story of President Garfield’s death is not included here in any detail, but it is worth looking up, if only to get a sense of how slowly some things changed. Candice Millard’s Destiny of the Republic: A Tale of Madness, Medicine and the Murder of a President (2011) is an excellent place to start.
Young people today (finally, I’m old enough to use that cliché) seem to have no real conception of how bad things were for women and, more important, could be again. The problems women faced in 1883 are not exaggerated here. However, please note that I am not claiming that all women were unhappy. Far from it, but not quite far enough. Some things to remember:
1. There was a period of several decades where male physicians were free to experiment with new procedures, no matter how specious the theoretical underpinnings, with little or no oversight from their peers or the law.
2. Women who did not adhere to the ideals of the time, whose interests and behaviors were considered abnormal and unnatural, were sometimes committed to hospitals and asylums, and in extreme cases they were subjected to castration and female circumcision. This came about in part because the men who ruled their lives decided that the female reproductive organs were the source of insanity. The aspects of the story that touch on these subjects are based on medical texts and medical journal articles of the time, as well as on current academic research. Readers familiar with the time period and subject will wonder why there is no mention of Dr. J. Marion Sims, who for decades was considered the father of modern gynecology until historians looked more closely. His absence from this story has to do with his absence from New York during the novel’s time span; I am not and should not be construed as an apologist, nor would I rationalize his systematic violation of the rights of women, free or slave, white or black, in his care.
3. Women were just beginning to get access to higher education. In large cities there were women’s medical colleges, but it was a good while later that they were admitted to the traditional institutions. Research on the early history of women physicians and surgeons comes from a wide variety of sources, most especially from Regina Markell Morantz-Sanchez’s work on Mary Putnam Jacobi and Mary Amanda Dixon. Susan Wells’s Out of the Dead House: Nineteenth-Century Women Physicians and the Writing of Medicine was tremendously useful. Other authors whose work in this area I found invaluable include Arleen Marcia Tuchman, William Leach, and Judith Walzer Leavitt. Sources differ on the numbers, but in 1883 about twenty African American female medical school graduates were practicing in the United States. Sophie’s history is inspired in part by the life stories of those indomitable women.
4. Nineteenth-century attitudes toward and understanding of sexuality and reproduction and the politics of birth control and abortion are hugely complex topics. Especially helpful in sorting through the murk were Timothy Gilfoyle’s City of Eros: New York City, Prostitution, and the Commercialization of Sex, 1790–1920; Linda Gordon’s The Moral Property of Women; G. J. Barker-Benfield’s The Horrors of the Half-Known Life: Male Attitudes toward Women and Sexuality in Nineteenth-Century America; and George Chauncey’s Gay New York: Gender, Urban Culture, and the Making of the Gay Male World, 1890–1940. These are crucial works I went back to many times.