Leopold, Ellen 1944-

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LEOPOLD, Ellen 1944-

PERSONAL: Born 1944. Education: Graduate of Radcliffe College (now part of Harvard University), 1966.

ADDRESSES: Offıce—Women's Community Cancer Project, c/o The Women's Center, 46 Pleasant St., Cambridge, MA 02139. E-mail—eleopold@mediaone. net.

CAREER: Writer. Member of Women's Community Cancer Project, Cambridge, MA.

WRITINGS:

(With Ben Fine) The World of Consumption, Routledge (New York, NY), 1993.

A Darker Ribbon: Breast Cancer, Women, and TheirDoctors in the Twentieth Century, Beacon Press (Boston, MA), 1999.

SIDELIGHTS: After surviving breast cancer, Ellen Leopold sought to write a book about the disease that would bridge the gap between already existing medical books on the subject and the many personal accounts written by cancer sufferers. The result is A Darker Ribbon: Breast Cancer, Women, and Their Doctors in the Twentieth Century. Here, Leopold strives to show how the attitudes of physicians toward breast cancer have often had negative consequences for their patients, and she expresses her belief that much of this suffering is the result of sexual politics within the medical community.

A Darker Ribbon is divided into three main parts. First, Leopold discusses the earliest surgical treatment for breast cancer, the radical mastectomy, a procedure devised by William Stewart Halsted in the 1890s that involves removing not only a cancerous breast but also much of the muscle tissue and other tissues surrounding the breast. Women undergoing this procedure suffered many adverse physical side effects and emotional trauma, but Halsted's insistence that the procedure increased survival rates meant that the radical mastectomy remained the preferred course of treatment until as recently as 1979. In the next section of Leopold's book, the author reproduces two sets of doctor-patient correspondence. The first set of letters, dating between 1917 and 1922, records Halsted's responses to one of his patients, Barbara Mueller (her real name is not used). The second set of letters comprises correspondence between Rachel Carson, the environmental activist and author of the seminal work Silent Spring, and her doctor, George Crile, Jr., between the years 1960 and 1964. In the Halsted-Mueller correspondence, the doctor never tells his patient what disease she actually has; in the Carson-Crile correspondence, the patient is initially kept in the dark, too, but with Carson's insistence Crile eventually responds with truth and compassion. Finally, in the last section of the book Leopold makes her case for political activism to change the medical community's attitudes toward its female patients. Although less radical lumpectomies, which remove much less tissue and have been shown to be just as effective as full mastectomies, are now available to women, Leopold maintains that chauvinism in the male-dominated world of medicine is still a problem.

Throughout A Darker Ribbon, Leopold questions why physicians insisted on using the radical mastectomy for so long, even when they knew how damaging it was to their patients, as well as why so many women passively accepted the treatment. This insistence on relying on only one treatment, the author further insists, prevented or slowed research on other possible ways to attack breast cancer. Deborah Stone, summarizing Leopold's explanation in an American Prospect review, wrote: "Leopold has two answers. The small one is this: Radical mastectomy is just another act of violence against women, and the persistence of mastectomy is made possible by male domination of women. (She's more subtle, but the story comes down to this.) The big answer, though, gets it right on the money: 'Once the basic treatment paradigm (radical surgery) has been put in place and become more readily available, its position could only be consolidated with the active support of the population it was designed to serve.' Read the book as a story about how the cancer establishment got the active support of the American population, and you've got a new window on twentieth-century medical history."

Some reviewers of A Darker Ribbon objected to Leopold's assertion that the continuation of radical mastectomies was a symptom of sexual politics. For example, New York Times Book Review critic Jerome Groopman asserted that Leopold does not give the whole picture of the history of medical attitudes in the early twentieth century. Thus, she neglects to note for the reader that surgical treatments for men could be just as gruesome. As evidence, Groopman discussed how prostate cancer "was routinely treated by a radical resection that damaged pelvic nerves and vessels and left the patient impotent. When metastases appeared, men were castrated, since testosterone seemed to promote cancer growth. Does this mean that urological surgeons were, consciously or subconsciously, acting out as alpha males to dominate and abase vulnerable men of the tribe?" Groopman asked skeptically. The critic further noted that, contrary to Leopold's assertion, chemotherapy was not necessarily known to be effective against breast cancer, as doctors found that this treatment did not always work on all types of cancer. Although Groopman acknowledged that medicine has suffered in the past from ignorance and even sexism, he wrote that "Leopold's assertions are extrapolations from ideology and lack supporting evidence."

Despite such opinions, other reviewers found much of value in A Darker Ribbon. For instance, Kirsten E. Gardner, writing in the Journal of Women's History, was enthusiastic about Leopold's use of doctor-patient correspondence. "These letters are wonderful to read and they offer a fascinating glimpse of intimate patient-doctor interactions," Gardner stated. Stone, who also noted as Groopman did how Leopold seems to treat breast cancer as if it were an isolated case independent of other cancer treatment procedures, nevertheless felt that, this flaw aside, A Darker Ribbon is "a path-breaking inquiry into the sociopolitical history of cancer writ large."

BIOGRAPHICAL AND CRITICAL SOURCES:

PERIODICALS

American Prospect, June 19, 2000, Deborah Stone, review of A Darker Ribbon: Breast Cancer, Women, and Their Doctors in the Twentieth Century, p. 92.

Booklist, October 15, 1999, William Beatty, review of A Darker Ribbon, p. 403.

Business History, April, 1995, Michael Winstanley, review of The World of Consumption, p. 171.

Journal of Women's History, spring, 2002, Kirsten E. Gardner, "Gender and Medicine: Blurring the Boundaries of Tradition," p. 183.

Library Journal, October 1, 1999, Barbara M. Bibel, review of A Darker Ribbon, p. 126.

New York Times Book Review, January 9, 2000, Jerome Groopman, "The Sexual Politics of Cancer."

Signs, winter, 2002, Carole Pateman, review of ADarker Ribbon, p. 557.