Customs and fashions were changing as well. At the dinner table, the two-pronged fork was changing to four prongs, and good manners required not using it with the left hand anymore but moving it to the right.

In 1800, only eighteen years before Mary Todd’s birth and for the first time in fashion history, a shoe for the right foot was contoured differently from one for the left foot. Trousers began to replace breeches in Paris by 1821, and by 1823, men were transitioning to trousers in America as well. In 1830, stiff white collars would begin to make men’s social occasions miserable, while in the same year it became fashionable for women’s sleeves to expand enormously. During the 1850s, women sometimes dared to wear those scandalous items of attire called “bloomers.” More prosaically, in California’s mining camps, more and more men were wearing Levi Strauss’s utilitarian creation—jeans.

The Art of Healing—and Killing

Sadly, medical science was not advancing at the same rate. Men and women of the nineteenth century were morbid about disease and death, and for a very good reason:  no one—least of all doctors—seemed to know what caused disease. More to the point:  no one knew what caused one patient to recover and another to die. All people knew was that when a disease hit a given community, some lived and some died. Doctors took credit for the former and blamed God for the latter. Terrible visitations such as cholera took 4,000 lives in New York and the Carolinas in 1831 and 1832. Smallpox killed 13,000 Indians in 1838. And in 1843, yellow fever ravaged the Mississippi Valley, to the tune of 13,000 lives.

Those who could afford doctors were often worse off than those who could not, as misdiagnosis was almost a given, pills were often as big as cherries, nostrums might contain almost anything, and the favorite all-purpose remedy of the day was bleeding the patient with leeches. Not even the high and mighty were spared. When sixty-seven-year-old George Washington contracted “quinsy” (acute laryngitis) on December 13, 1799, his solicitous doctors bled him four times, inflicted garglings of molasses, vinegar, and butter on him, and for good measure plastered a blister of cantharides on his throat. Not surprisingly, he was dead by the next day.

Neither did doctors understand what germs were, what an antiseptic was, or why they should want to keep anything sanitary. On the frontier, baths were rare. One might take a bath or two during the summer months and none at all during the rest of the year. And when baths were given—well into the early twentieth century—chances were that the entire family, beginning with the oldest adult and ending with the smallest child, would climb into the same little tub and wash in water that got filthier with each immersion. The folk saying, “Don’t throw the baby out with the bath water,” resulted from documented incidents of babies drowning in bath water so filthy that no one had noticed they’d slipped under the surface.

The average man in the nineteenth century would go through three wives in a lifetime. Nobody seemed to know why women died so often in childbirth. In the middle of the century, the Hungarian physician Ignaz Philipp Semmelweis (1818–1865) discovered that there was a simple reason why so many mothers died of a particular childbirth complication, puerperal fever:  neither doctors nor midwives bothered to wash their hands between patients. The result was that they would carry death on their hands as they moved from one patient to another.

The medical profession so ridiculed Semmelweis for his “theory” that he died young (of a broken heart, some say). It would not be until half a century later that the medical profession would correct the mistake that continued unnecessarily to take the lives of millions of women. Today, women have not only caught up with men in terms of longevity but now outlive men by seven or eight years.