Louise Klehm found these prospects so exciting that she entered the Chicago Baptist Hospital's three-year nursing program in 1893. Alas, disillusionment set in before graduation day, for Klehm was only one of thousands of young women with the same notion.

Still, though the market was glutted with newly-qualified nurses, Klehm was a mature and intelligent student, and she graduated in 1896 with two offers of employment in hand - one from with a physician in Minneapolis, the other as assistant head of nursing at the hospital where she had studied. There was just one problem. Neither choice offered enough money to live on. Contemplating both with equally lukewarm enthusiasm, she turned to her usual source of wisdom and strength: her father, back home in Niles Center.

George Klehm did not let her down. He gave careful thought to the question of his daughter's career before writing to her on September 18, 1896, at the Chicago Baptist Hospital.

"The position of nurse for some eminent physician, would perhaps be all right, but ... this doctor is at Minneapolis."A true father of the late Victorian Age, George pounced on this distance on the grounds that she would be away from all her relatives. "It would be rather dangerous," continued George, "to trust your fate to a strange man in a strange city, away from all relatives and before you make a move in that direction, you should have positive evidence as regards the moral character and standing of this physician." Far better, George declared, to accept the assistant head nurse position at the college, even though the salary was small.

Louise accepted her father's advice, but she was not in her hospital position for long. In April 1898, President William McKinley declared war on Spain soon after the mysterious explosion of the battleship USS Maine in Havana harbor. In company with nearly 1,600 other nurses, Louise enlisted in the Army Medical Corps and was sent to Miami to care for wounded soldiers in a new but unfinished hospital. But rigid standards of hospital hygiene not withstanding, the medical corps had reckoned without the patients themselves, who insisted on drinking polluted well water in preference to the boiled water provided especially for them. The result, predictably, was a raging typhoid epidemic. Plans for the hospital were hastily scrapped, and the 154 wounded from Illinois, with Nurse Louise Klehm in attendance, were sent back home to convalesce at Fort Sheridan, about fifty miles north of Chicago.

Neither the Illinois nurses nor the soldiers missed much in the way of action. The Cuban battlefronts were silent by summer's end, and the Spanish-American War was over before the year was out.

For Klehm, the time was ripe for a new challenge: medical school. She'd asked her father for advice about this some time earlier, but the letter he sent to her at the Baptist Hospital was discouraging. "The study of medicine would consume about four years of your life and the results would give you a chance to bury yourself in some charitable institution for the rest of your lifetime," he wrote, expecting the matter to be closed. But he had not reckoned with his daughter's determination. Louise had made up her mind to go to medical school, and medical school it would be.

It was a difficult time for a woman to aim for a medical career. Across the nation the medical profession, a traditionally masculine stronghold, had cautiously welcomed the first 200 women into the fraternity by 1860. By 1880, 2,423 female colleagues had filled the ranks. But by 1900 more than 7,000 female physicians were clamoring for full acceptance.

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The patriarchy resisted. Women physicians, the besieged men blustered, were too unreliable. Matters such as chemistry and anatomy were subjects too taxing for the feminine brain. As if all this were not enough, cartoons supporting the medical establishment took delight in depicting women doctors daring to chart the profession's future course, and — worst of all — besting their male colleagues for the patient's dollar!

Persistent hostility often drains the joy from ambition, but the twenty-eight-year-old Louise was not to go down in defeat. In 1898, with eyes focused firmly on her goal, she entered Chicago based University of Illinois, a coeducational medical school then accepting women for the second year in a row.

She made a wise choice. Northwestern University, also Chicago-based, would soon bow to establishment pressure, abruptly closing its Women's Medical School just two months short of graduation. In contrast, students at the University of Illinois were secure in the firm support of their dean, William E. Quine, a man who was impressed by the dedication and hard work of his female students. In this serene atmosphere, Louise and her fourteen female classmates were able to do their best work, graduating together without incident in 1902.

Once graduation was over, however, Dean Quine's support could not force hospitals to accept his female graduates as interns, even though a scant two years later an estimated 50 percent of all medical graduates went on to voluntary further training. In Boston, only the New England Hospital accepted women for internships, and only six other American hospitals, the Chicago-based Women's and Children's Hospital among them, regularly accepted women interns. Few of these newly-trained doctors were able to find placement for further training anywhere in the country; most were forced to turn to more liberal hospitals in Europe

Klehm was lucky. One of her medical school instructors was Rachelle Yarros, M.D., a passionate supporter of both birth-control and adequate medical care for the poor. At the time of Louise's graduation, Yarros happened to be living and working at Hull House, Jane Addams' settlement house for Chicago's inner-city poor immigrants. Overworked herself, she gladly accepted the newly qualified physician for a three-month internship.

Louise Klehm's nursing class on the steps of Chicago Baptist Hospital. Klehm is seated at the Jar left in the next-to-last row.

Brief as it was, this internship taught Klehm a great deal. She saw poverty so intense and painful — babies were born into the world without even a rag to wrap them in — that thereafter, she would always set aside food and clothing for the less fortunate. Likewise, Louise learned about the social and medical issues surrounding the prevention of "involuntary motherhood," and she delivered seventy babies, honing her skills so they were equal to any emergency. It was all very exhilarating, but it was also exhausting, and it took her into places of unbelievable filth. Characteristically, she tried to shield her family from the worst of it, but didn't always succeed.

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"When she would come home at night from delivering a baby or saving a dying man from pneumonia, she would stand in the bathtub and undress to shake the vermin from her clothing," her sister Alma later recalled.

But three months of hands-on experience were not enough for Klehm: she decided to hone her surgical skills in Europe, specifically in Berlin and Vienna, where women doctors were more accepted.

By the time she went into family practice in her hometown, A. Louise Klehm, M.D., was a highly-educated and poised woman in her mid- thirties. A portrait photograph taken at this time shows a calm, assured face with deeply chiseled bone structure and steady, self-confident gaze. The confidence was fully justified, buttressed as it was by knowledge of the latest techniques, and underlined by her two constant companions: the first, a case full of necessities for any needy families she might encounter; the second, a capacious black doctor's bag stocked with medications such as calomel (useful against for intestinal parasites), quinine, the emetic called ipecac, and aspirin, the latest wonder-drug. Sharing the bag were her instruments: stethoscope, thermometer, opthalmoscope and sphygmograph, plus scissors, needles and catgut for stitching, various scalpels and other cones for surgical use, and, of course, obstetrical forceps in case of difficult deliveries.

Everything came in handy, for she never knew what she might find once she arrived at a patient's bedside. Sometimes there was a welllighted bedroom, clean and conveniently close to St. Francis Hospital in neighboring Evanston, where she was on staff. More often she found herself delivering a baby, or setting a broken bone in a lonely farmhouse lit by guttering oil lamps, with only a trembling member of the patient's family to assist. Despite the hours of travel and the long nights at a patient's bedside, however, the fees suggested by the American Medical Association Bluebook of 1892 do not suggest that Klehm ever became wealthy: Fairly standard fee for a delivery, fifteen dollars; emergency house-call, five to twenty-five dollars; fine dressing of superficial wounds e.g. sprains, five to twenty-five dollars.

By 1918, Niles Center, soon to be renamed Skokie, was becoming more suburban than rural. Peaceful and productive, the little town boasted an auto dealership, a painter, and a photographer, as well as a butchery, a dairy, and even an insurance office run by Dr. Klehm's brother, George. There were also paved roads, so the doctor was able to see her homebound patients far faster than she had ever done before.

This stood her in good stead that year, when the worldwide influenza epidemic struck. Dr. Klehm spent many frantic hours making rounds—fifty-one on one record day, according to her faithful sister and sometimes driver, Alma, an indispensable companion at such times.

There came a time in the mid 1930s when advancing years caught up with Dr. Klehm. The finale to her working years announced itself with cancer of the eye, which forced her to sell her practice to a female colleague in 1939. A methodical woman to the last, she left explicit instructions on her retirement that all outstanding patients' bills were to be torn up. That way, she said, nobody would owe her anything....

Louise Klehm, M.D., died in St. Francis Hospital on February 22, 1941, just months before the United States entered World War II. Her funeral service, held on the afternoon of February 24 at the Haben Funeral Home, was attended by so many people that they overflowed into the upstairs living quarters of the Haben family. It was a fitting tribute to the Skokie's first lady of family practice.

Gillian Wolf is a freelance writer from Skokie, Illinois. Her interests are history and biography.

further Reading Abram, Ruth, ed. Send Us a Lady Physician: Women Doctors in America, 1835-1920. New York, Norton & Company, 1985. Guthrie, Douglas, A History of Medicine. London, Lippincott, 1946. Walsh, Mary Roth, Doctors Wanted: No Women Need Apply. New Haven, Yale University Press, 1977.

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