In March 2024, a worn cardboard box arrived at the office of Sarah Chen, a medical historian at Boston University. Inside was a photograph from 1887 showing two women standing outside a modest wooden house. The older woman, perhaps in her forties, wore a simple dark dress with a white apron. Beside her stood a younger woman, barely twenty, with the same determined set to her jaw.
Both wore identical necklaces with small pendants carved from wood or bone, inscribed with botanical symbols. The donation form said the items came from an estate sale in Cambridge. The family knew little about them. There was also a small leather notebook in rough condition and a cloth pouch containing a necklace identical to the one in the photograph.
Sarah unwrapped it and saw the symbols clearly: chamomile, raspberry leaf, and blue cohosh, an herb midwives once used during childbirth. On the back of the pendant were tiny initials: CM and AK. The notebook belonged to Katherine Morrison, born Katherine O’Sullivan in County Cork, Ireland. She had arrived in Boston in 1868 at age nineteen, married a dock worker named Thomas Morrison in 1869, and was widowed in 1876 when tuberculosis claimed him.
The notebook spanned 1885 to 1890 and contained records of more than two hundred births. The entries were matter-of-fact: the mother’s name, the baby’s condition, payment or lack thereof. Some families paid in eggs and bread. Others paid nothing.
But the notebook revealed more than births. The hospital on Beacon Street had turned away an Irish widow whose husband died in a factory accident. A Black woman came to Katherine in secret, because the white doctors would not see her. When Katherine recorded these cases, she documented a system of deliberate medical neglect based on ethnicity, poverty, and social status.
Cross-referencing the names with city records, Sarah found that of the 247 births recorded between 1885 and 1890, only 89 appeared in hospital records. The other 158 existed only in Katherine’s handwriting. These were children born to women the medical establishment refused to serve. Katherine had not simply practiced charity.
She was running a business. A heated editorial in an 1883 medical journal complained about unregulated midwives charging fees far below what physicians could offer, creating an unfair marketplace. Katherine had earned enough to purchase a house outright in 1884, a significant achievement for a widowed immigrant woman with no recorded employment. The notebook made occasional references to “my apprentice” and “the girl who helps me.
” A letter tucked into the back revealed her name. Anna Kelly wrote to Katherine describing a difficult twin birth she had managed successfully, using a technique Katherine had taught her. Anna was born in Cork in 1867, immigrated to Boston in 1883 at age sixteen after both parents died of fever, and was placed in domestic service with a widow named Katherine Morrison. By the 1890 census, she was listed as Katherine’s ward, not her servant, with an occupation of medical assistant.
Katherine had taken in an orphan, trained her in a profession, and the relationship had evolved into something like mother and daughter. The map of Katherine’s work showed she traveled all over Boston. The addresses clustered in the North End, where Italian immigrants crowded into tenements; the West End, home to Irish and Jewish families; and the South End, where Black families lived in cramped boarding houses. She charged on a sliding scale.
Wealthy families paid five dollars. Working families paid two. The poorest paid nothing, or paid in goods: a loaf of bread, a repaired shoe, a bundle of firewood. Katherine accepted it all and recorded it meticulously.
Some entries were marked with a small star in the margin. These births had no names attached, just initials and a location. Both women always attended together. Sarah realized these were women in crisis, women who needed protection and secrecy beyond medical care.
Katherine and Anna were operating an underground network, helping women escaping abusive situations, women whose pregnancies had to be hidden, women with nowhere else to turn. The necklaces were a signal, a way for women in need to identify people who could be trusted without judgment. The network was larger than Sarah had imagined. A retired teacher named Eleanor Rodriguez contacted her after seeing a genealogy forum query.
Her great-great-grandmother Rosa Martinez, a Mexican immigrant pregnant and alone in 1888, had been saved by two women with necklaces like this. They found her a place to stay, helped her find work, and taught her English. They asked no payment except that she pass on the kindness. Rosa kept a piece of embroidered cloth with the botanical symbols her entire life, and told her family that the older midwife was Irish, stern but kind, while the younger one was barely older than Rosa herself and held her hand through the birth.
Sarah expanded her search across New England. Responses flooded in from Providence, Worcester, and Boston. An Italian great-grandmother delivered by a midwife wearing a wooden pendant. A Polish ancestor who wrote about the women with flower necklaces.
A Chinese immigrant family with a faded drawing of botanical symbols. The network spanned multiple cities, multiple ethnic communities, and operated from the 1870s into the early 1900s. Experienced midwives trained apprentices, who established their own practices and trained others. The symbols taught both remedies and values: compassion, discretion, accessibility.
Women who wore them pledged to serve anyone who needed help. A diary found in the archives of a Boston settlement house provided the clearest picture of Katherine’s philosophy. A worker named Margaret recorded that Katherine attended to a family for two days until mother and child were stable, refusing payment beyond a meal and some coal. When Margaret asked why she did this work for so little, Katherine replied: “These women have no voice in the halls where decisions are made about their bodies and their lives.
The least I can do is ensure they have a voice in their own births. ”
The final piece came from Anna herself. An obituary in the Boston Globe from 1947 described her as a retired nurse known for charitable work and dedication to women’s health. She had donated her personal papers to the Cambridge Historical Society in 1945.
Among them was a continuation of Katherine’s notebook, running from 1890 to 1923. In the front was a letter Katherine had written in 1889. It said the necklace was a promise: to serve those whom others turn away, to treat every woman with dignity. Anna added her own note below.
She received the letter on the day Katherine died, June 14, 1889, at age twenty-two. She recorded that she trained forty-three women over the years, each receiving a necklace, each making the same promise. Sarah presented her findings at a medical history conference in October 2024. She displayed the photograph of the two women with their matching necklaces.
The work they had done, serving patients rejected by hospitals because of ethnicity, poverty, or social status, had remained deliberately invisible because official recognition would have brought restrictions preventing them from serving the people who needed them most. The photograph, Katherine’s notebook, Anna’s records, and the necklace were donated to the Smithsonian Institution’s Collection on Women’s Medical History. Sarah’s article appeared in the Journal of American Medical History. Months later, a midwife practicing in rural Vermont wrote to Sarah.
Her grandmother, who died in 1998, had left her a wooden pendant carved with botanical symbols. The grandmother had been trained by a woman who claimed to be part of a long tradition of midwives serving marginalized communities. The midwife wore the pendant when she attended births. She had not understood what it meant until she read Sarah’s article.
“I’m honored to carry on what they started in my own way, in my own time,” she wrote. “The work continues. “