of the medical profession is one of the most interesting of modern
times. This movement has already achieved much, and far more than is
often supposed. Yet the interest lies even less in what has been so far
achieved, than in the opposition which has been encountered: in the
nature of this opposition; in the pretexts on which it has been
sustained, and in the reasonings, more or less disingenuous, by which it
has claimed its justification. The history, therefore, is a record not
more of fact, than of opinion. And the opinions expressed have often
been so grave and solid in appearance, yet proved so frivolous and empty
in view of the subsequent event, that their history is not unworthy
careful consideration among that of other solemn follies of mankind.
In Europe, the admission of women to the profession of medicine has been
widely opposed because of disbelief in their intellectual capacity.[32]
In America it is less often permitted to doubt—out loud—the intellectual
capacity of women. The controversy has therefore been shifted to the
entirely different ground of decorum.
At the very outset, however, two rival decorums confronted each other.
The same centuries of tradition which had, officially, reserved the
practice of medicine for men, had assigned to women the exclusive
control of the practice of midwifery. It was assumed that midwifery did
not require the assistance of medical art,—that the woman in labor
traversed a purely physiological crisis, and required only the
attendance of kindness, patience, and native sagacity,—all obtainable
without scientific knowledge, from her own sex. This being taken for
granted, the propriety of limiting such attendance to women appeared so
self-evident, that, from the beginning of the world till the eighteenth
century A.D., the custom was not seriously questioned. There is an exact
parallelism between the relations of men to midwifery and of women to
medicine. The limitation of sex in each case was decided by a tradition
so immense, as to be mistaken for a divinely implanted instinct,
intended by Providence as one of the fundamental safeguards of society
and of morals. In each case the invasion by one sex of a “sphere”
hitherto monopolized by the other, aroused the coarsest antagonism of
offended delicacy. In each case finally, a real basis existed for the
traditional etiquette: there _was_ some reason for protesting against
the introduction of the male accoucheur into the lying-in room, or of
the ardent young girl into the medical school. But in each case,
whatever reasons for protest existed, were outnumbered and outweighed by
others, to whose greater importance they were finally compelled to give
way. Other things being equal, it _was_ unpleasant for a woman to be
attended in the crisis of her confinement by a man. But when the
necessity for knowledge was recognized, when men became skilled while
midwives remained ignorant,—the choice was no longer possible; the
greater decorum of female midwifery was obliged to yield to the greater
safety of enlightened masculine practice. Similarly, it _was_
occasionally unpleasant for young women students to find themselves
engaged in certain subjects of medical study together with classes of
young men. But in proportion as midwifery became enlarged by the new
province of gynæcology, did occasions multiply on which it was extremely
unpleasant for non-medical women to be medically treated by men. The
difficulties of educating a relatively few women in medicine were
compelled to be accepted, in order to avert the far greater difficulties
of medical treatment for a very large number of women.
The history of medical women in the United States, to which these pages
exclusively apply, may be divided into seven periods, as follows:
First, the colonial period of exclusively female midwifery,[33] many of
whose practitioners, according to their epitaphs, are reported to have
brought into the world one, two, or even three thousand babies apiece.
The Mrs. Thomas Whitmore of Marlboro, mentioned in the note, is
especially described as being “possessed of a vigorous constitution, and
frequently traveling through the woods on snow-shoes from one part of
the town to another by night and by day, to relieve the distressed.”[34]
During this period of female midwifery, the medical profession proper of
the colonies remained entirely unorganized and inarticulate.[35] Without
making especial inquiry, a superficial observer could have almost
overlooked the existence of doctors, as a special class, in the
community.
There followed, however, a second period, that, namely, of the
Revolution, and the years immediately preceding and following it. During
the former, physicians began to travel to Europe for instruction. During
the Revolutionary war their public services in the military hospitals,
though apparently not very useful to the sick,[36] yet served to bring
the profession, for the first time, out of obscurity; and the
opportunities afforded for the collective observation of disease on a
large scale, first breathed the spirit of medical science into the
American profession. The first achievement of the new-born interest in
medical art and education was the expulsion of “females,” from even the
outlying provinces of the profession, and from their world-old
traditional privileges as accoucheurs.[37] It was a harsh return to make
for the services rendered to the infant settlements by these valiant
midwives, who had been tramping through the snow by night and by day to
bring into a very cold world the citizens of the future republic![38]
Third. After this, however, came a period of reaction. In 1848, a Boston
gentleman, Mr. Samuel Gregory, began to vehemently protest against the
innovation of “male midwives,” and, opened a crusade on behalf of the
women, with something of the pathetic ardor of the Emperor Julian for a
lost cause.[39] To judge by the comments of the public press, Mr.
Gregory’s protest against “man-midwifery” awoke sympathetic echoes in
many quarters. At the present day the interest in the movement thus
roused, at once progressive and reactionary, lies chiefly in the
remarkable similarity between the arguments which were then advanced
against the intrusion of men into midwifery, and those which were
subsequently urged against the admission of women to medicine. Thus:
“The employment of men in midwifery practice is always grossly
indelicate, often immoral, and always constitutes a serious temptation
to immorality.”—_Summary of Mr. Gregory’s argument in “Man-Midwifery
Exposed,”_ 1848.
“I view the present practice of calling on men in ordinary births, ...
as a means of sacrificing delicacy and consequently virtue.”—_Thomas
Ewell, M.D., of Virginia._
“The practice (of male midwifery) is unnecessary, unnatural, and
wrong,—it has an immoral tendency.”—_W. Beach, M.D., New York._
“There are many cases of practice among women ... in which the sense
of propriety would decide that the presence of a female practitioner
is more desirable than that of a man.”—_New York Observer_, 1850.
“There are a few self-evident propositions which it would be
questioning the common sense of mankind to doubt. One is that women
are by nature better fitted than men to take care of the sick and the
suffering.”—_Godey’s Lady’s Book_, 1850.
“The especial propriety of qualifying women to practice among children
and their own sex, will be admitted I hope by all.”—_Rt. Rev. Bishop
Potter_, 1850.
“We have long been persuaded that both morality and decency require
female practitioners of medicine. Nature suggests it; reason approves
it; religion demands it.”—_Northern Christian Advocate_, 1850.
“This is one of the most important projects of the day for the
improvement of the condition of women.”—_Zion’s Herald_, 1850.
“The employment of men as ‘midwives’ is a modern custom, and one not
to be commended.”—_Phil. Saturday Post_, 1850.
“To attend medical clinics in company with men, women must lay aside
their modesty. There are still enough _gentlemen_ who would blush to
expose their mothers or sisters or wives to what, before women, would
be improper and indecent.”—_Letter to editor N. Y. Med. Record, 1884,
by M. K. Blackwood._
“History, physiology, and the general judgment of society unite in the
negative of woman’s fitness for the medical office.”—“_Woman and her
Physician._” _Lecture, Theoph. Parvin, Prof. Dis. Women_, 1870.
“If I were to plan with malicious hate the greatest curse I could
conceive for women, if I would estrange them from the protection of
women, and make them as far as possible loathsome and disgusting to
man, I would favor the so-called reform which proposed to make doctors
of them.”—_Editorial Buffalo Med. Journal_, 1869, p. 191.
“There are free-thinkers in the medical profession as there are
free-lovers in social life.... The opposition of medical men arises
because this movement outrages all their enlightened estimate of what
a woman should be. It shocks their refined appreciation of woman to
see her assume to follow a profession with repulsive details at every
step, after the disgusting preliminaries have been passed.”—_Sherry,
Med. and Surg. Reporter, July 6, 1867._
“It is obvious that we cannot instruct women as we do men in the
science of medicine; we cannot carry them into the dissecting room and
hospital; many of _our_ more delicate feelings, much of _our_ refined
sensibility must be subdued before we can study medicine; in females
they must be destroyed.”—_Remarks on Employment of Females as
Practitioners, Boston_, 1820.
“The ceremonies of graduating Miss Blackwell at Geneva may well be
called a farce. I am sorry that Geneva should be the first to commence
the nefarious process of amalgamation. The profession was quite too
full before.”—_Letter by D. K. to Boston Journal, Feb. 1849._
“The bare thought of married females engaging in the medical
profession is palpably absurd. It carries with it a sense of shame,
vulgarity, and disgust. Nature is responsible for my unqualified
opposition to educating females for the medical profession.”—_Dissert.
on Female Phys. by N. Williams, M.D., read before a N. Y. Med. Soc._,
June 6, 1850.
“Females are ambitious to dabble in medicine as in other matters, with
a view to reorganizing society.”—_Edit. Boston Med. and Surg. Jour._,
1852, p. 106.
“The serious inroads made by female physicians in obstetrical
business, _one of the essential branches of income to a majority of
well established practitioners_, make it natural enough to inquire
what course to pursue.”—_Ibid._, Feb. 1853.
These parallel columns might be extended much further, did our space
permit. We cannot, however, pass by the following gem of eloquence from
an English source, but quoted in the Cincinnati _Lancet and Clinic_ for
1881. It is from the address at the British Medical Association by the
President of that year:
“I am not over-squeamish, nor am I over-sensitive, but I almost shudder
when I hear of things that ladies now do or attempt to do. One can but
blush, and feel that modesty, once inherent in the fairest of God’s
creation, is fast fading away. You gentlemen, who know the delicacy of
women’s organization,—you must know that constitutionally they are unfit
for many of the duties of either doctor or nurse.
“May not habit so change that fine organization, that sensitive nature
of women, as to render her dead to those higher feelings of love and
sympathy which now make our homes so happy, so blessed?
“Will not England’s glory fade without its modest sympathizing women,
and its race of stalwart youths and blooming maidens?
“You now, gentlemen, know my views as to the propriety of ladies
_becoming doctors or nurses_.”[40]
The Fourth period of woman’s medical history was initiated when Mr.
Gregory, supported by the popular enthusiasm he had aroused, succeeded
in opening a School of Medicine (so called) for women, in Nov. 1848.[41]
The first term lasted three months: a second term began the following
April, 1849;—and with the announcement for the second year it was
declared that the twenty pioneer pupils had not only followed the
lectures, but “had attended above 300 midwifery cases with the most
satisfactory success.”
In the prospectus issued for the second year of the school, Mr. Gregory
brought forward a new set of arguments in its support, in addition to
those previously adduced. There was then (1849) in New England, a
surplus female population of 20,000 persons,—and “hundreds of these
would be willing to devote any necessary length of time to qualify
themselves for a useful, honorable, and remunerative occupation.” They
could afford, moreover, to give their services at a much cheaper rate
than men, charging about a third the ordinary fees,—thus $5 instead of
$15 for attendance on a confinement case.
Thus not only would the morals of the community be preserved, but the
burdens on its purse be considerably lightened by the employment of
educated women as obstetricians. As the medical profession had just
become keenly alive to the peculiarly lucrative character of obstetrical
and gynæcological practice, this suggestion that it might now profitably
be undersold naturally aroused the keenest resentment. It was soon
retorted that the cheaper practitioners were to be prepared by a system
of education so cheap as to be absolutely worthless; and unfortunately
the early history of the first medical schools for women entirely
justified this accusation.
To support Mr. Gregory’s school, a Female Medical Education Society was
formed in Boston, and incorporated with a state charter. Nothing seemed
at the outset fairer than the promises of the new college,—but it had
one fatal defect. There was no one connected with it who either knew or
cared what a medical education should be. It followed that, under the
name of medical education, was offered a curriculum of instruction, so
ludicrously inadequate for the purpose, as to constitute a gross
usurpation of the name,—in a word, to be an essentially dishonest
affair. And still more unfortunately, the same inadequacy, naïvely or
deliberately unconscious of itself, continued in greater or less degree,
to characterize all efforts for the isolated medical education of women
for the next twenty years. This, the fourth period of their medical
history,—deserves therefore to be considered by women rather as a
pre-medical or preliminary epoch; where purposes were enunciated that
were only to be fulfilled many years later.
The Gregory Medical School maintained a precarious existence until 1874,
when, by an enabling act of the Legislature, the funds were handed over
to the Boston University, just founded,—upon condition that women should
be admitted to the medical department of the latter. This condition was
punctually fulfilled; women students were rendered eligible to all
departments of the new university. But as the medical school, for some
reason, became exclusively homœpathic,—the fortunes of medical women in
the regular profession were not thereby greatly advanced.[42]
Now, however, the movement for women had widened and reached
Philadelphia, where two schools were started. One of these, the Penn
Medical School, ran a permanently unenviable career of unfitness, and
was finally extinguished. The other, the Woman’s Medical College of
Pennsylvania, was founded in 1850, and after a long and precarious
period of struggle, finally touched upon a solid basis of medical
realities, and thence began its prosperous modern career. In the mean
time, and fortunately for the cause, a new departure had been taken in
several other directions. The Gregory School had been founded with the
avowed intention of educating women for midwives; and it did not succeed
even in this limited aim, because it was either ignorant of or
indifferent to the rigid system of education imposed, wherever, as in
Europe, midwives are recognized and educated. In America, where
hostility to class distinctions is so profound as to interfere with the
recognition of even the intellectual distinctions which are alone
just,—it was probably a foregone conclusion that the various ranks in
medicine which exist in European countries would never here become
officially established.[43] But a startlingly long step was taken at a
stride, when, thirty years after the pæan of victory had been sounded
over the complete suppression of female midwifes, so that not even this
corner of possible medicine might remain in possession of women,—that
then, half a dozen women, unknown to each other, and widely separated in
this immense country, should appear almost simultaneously upon the
scene, and demand the opportunity to be educated as full physicians.
Their history marks a fifth period in the movement.
The first of this remarkable group of women was Harriet K. Hunt of
Boston.
This lady had for several years assumed the responsibility of practicing
medicine, while yet unprovided with a medical diploma. This was
reprehensible, but from a practical standpoint, the course seems to have
been justified by subsequent events. For when, in 1847, Miss Hunt
requested permission to attend lectures at the Harvard Medical School,
her request was promptly refused. After the graduation of Elizabeth
Blackwell at Geneva in 1849, Miss Hunt thought that the times might have
become more favorable, and, in 1850, repeated her application at
Harvard. In mobile America, three years may sometimes effect such a
change in sentiment as would require three centuries in the Old World.
On this occasion, five out of the seven members of the Faculty voted
“That Miss Hunt be admitted to the lectures on the usual terms, provided
that her admission be not deemed inconsistent with the statutes.”[44] A
week later, the President and Fellows of the University announced that
the statutes of the Medical School offered no obstacle to the admission
of female students to their lectures. But, on the eve of success, Miss
Hunt’s cause was shipwrecked, by collision and entanglement with that of
another of the unenfranchised to privileges. At the beginning of the
session, two, and later a third, colored man, had appeared among the
students, and created by their appearance intense dissatisfaction. When,
as if to crown this outrage to gentlemanly feeling, it was announced
that a _woman_ was also about to be admitted, the students felt that
their cup of humiliation was full, and popular indignation boiled over
in a general meeting. Here resolutions were adopted, remonstrating
against the “amalgamation of sexes and races.” The compliant Faculty
bowed their heads to the storm, yielded to the students, who, though
young and inexperienced, were in the majority, and might possibly
withdraw in a body to Yale,—and, to avoid the obloquy of rejecting,
under pressure, a perfectly reasonable request, advised the “female
student” to withdraw her petition. This she did; the storm subsided, and
the majesty of Harvard, already endangered by the presence of the negro,
was saved from the further peril of the woman. Miss Hunt returned to her
private medical practice, which, though unsanctioned by law and
condemned by learning, was so successful that, in 1872, she celebrated
her silver wedding to it.[45]
Thus, on this first occasion, it was not a sentiment of delicacy that
forbade the Harvard students to share their privileges with a woman; but
a sense of offended dignity of sex, which distinctly allied itself with
the other and equally touchy dignity of race. The odd idea was advanced
on this, as on so many other occasions, that whenever a woman should
prove herself capable of an intellectual achievement, this latter would
cease to constitute an honor for the men who had previously prized it.
Hence the urgent necessity of excluding women from all opportunity of
trying.
In 1849, “Diplomas and advanced courses of study were things entirely
outside the intellectual life of women.”[46] The pioneer female
colleges, the Troy Seminary and the Mt. Holyoke school, had scarcely
been founded,[47] and women everywhere received only the most
rudimentary education. On the other hand, the medical education of men,
was, as compared with the objects to be attained by it,—in about an
equally rudimentary condition. The intrinsic tests were so shifting and
unreliable, the standard of attainments so low, that it was
proportionately necessary to protect the dignity of the profession by
external, superficial, and arbitrary safeguards. Of these the easiest to
apply was the distinction of sex. It was often difficult to decide, in
the absence of intrinsic tests, whether a given individual were or were
not a competent physician: but it was of course always easy to recognize
that he was a man. This simple principle of distinction was adopted,
therefore, as the guiding rule in future controversies. All men, however
or wherever educated, were to be considered competent physicians, if
only they chose to say so themselves. And all women were correlatively
to be declared incompetent, no matter what care they had taken to
prepare themselves. The principle was well suited to crude and
uncultured societies, and became proportionately popular.
Elizabeth and Emily Blackwell were led to the study of medicine in a
different manner than Harriet Hunt, their immediate predecessor. While
still quite young girls, they were, by the sudden death of their father,
unexpectedly confronted with the necessity of supporting not only
themselves, but their mother, and a large family of younger brothers and
sisters. “Then we realized the infinite narrowness and pettiness of the
avenues open to women, and the crowds of competitors who kept each other
down in the struggle. We determined that we would endeavor to open a new
door, and tread a fresh path,—rather than push for a footing in one
already filled to overflowing.”[48]
In this determination a new key-note was sounded. The Blackwells, and
especially Elizabeth, were less the associates of Harriet Hunt, and of
their own immediate successors, than the spiritual daughters of Mary
Wollstonecraft, whose courageous demand for a wider field for her sex
had remained hitherto almost alone, like a voice crying in the
wilderness. They did not seek wider opportunities in order to study
medicine, but they studied medicine in order to secure wider
opportunities for all women.[49]
It was by sheer force of intellect, and of the sympathetic imagination
born of intellectual perception, that Elizabeth Blackwell divined for
women the suitableness of an occupation whose practical details were, to
herself, intrinsically distasteful. Among all the pioneer group of women
physicians, hers chiefly deserves to be called the Record of an Heroic
Life. For with her, the struggle with bitter and brutal prejudices in
the world was not sustained by the keen and instinctive enthusiasm for
medicine, which has since carried hundreds of women over
impossibilities. Rather was the arduousness of the struggle intensified
by a passionate sensitiveness of temperament, which, under a cold
exterior, rendered her intensely alive to the hardships of the social
obloquy and ostracism which she was destined to encounter in such
abundance.
Those accustomed to value ideas according to their intrinsive power, as
shown by their originality and their fruitful result, should admit that
there was real grandeur in this thought: the thought that the entire sex
might be lifted upon a higher intellectual plane, by means of a
practical work, for which, at the moment, not half a dozen people in
America discerned the opportunity. “The thorough education of a class of
women in medicine will exert an important influence upon the life and
interests of women in general.” “Medicine is so broad a field, so
closely interwoven with general interests, and yet of so personal a
character in its individual applications, that the coöperation of men
and women is needed to fulfill all its requirements.” “It is not
possible or desirable to sanction the establishment of an intermediate
class” [of midwives.][50]