the early careers of the pioneers in the movement, must nevertheless be
considered as a sort of pre-medical episode, analogous in many respects
to that of the entire American profession before the Revolutionary War.
And this notwithstanding, and indeed a good deal because during this
epoch some women were admitted to inferior or “irregular” schools,
already established, and because other medical schools were founded
exclusively for them. The Philadelphia school owed its foundation to the
most generous impulses: but knowledge and pecuniary resources were both
inadequate, and the active and bitter opposition of the medical
profession of the city was an almost insuperable obstacle in the way of
securing efficient assistance for instruction. The idea of the school
seems to have originated with Dr. Bartholomew Fussell, a poor
schoolmaster, who had been educated by an elder sister “to whom he
looked up with veneration; and he thought that such as she ought to have
a chance of studying medicine, if they desired.”[73]
A few friends were collected, the plan was matured, the charter secured,
and the school opened for the reception of students in 1850. During the
first four years the yearly sessions did not last more than four months;
but in the fifth annual catalogue the trustees announced with pride an
extension of the course to five and a half months, and claimed that this
was the longest course of instruction adopted by any medical college in
the United States. They further, and with evident sincerity, declared
that the curriculum of study was fully equal to that of any other
medical college.
The instruction consisted of rambling lectures, given by gentlemen of
good intentions but imperfect fitness, to women whose previous education
left them utterly unprepared to enter a learned profession, and many of
whom were really, and in the ordinary sense, illiterate. As fast as
possible the brightest students were chosen, after graduation, to fill
places in the Faculty, and among these one, Emmeline Cleveland, having
received a real education, at least for obstetrics, in Europe, returned
to Philadelphia to become a really effective teacher. For twelve years
scarcely any opportunity existed for the students of the college to see
sick people, an anomaly which would at the time have been considered
more outrageous in any other country than the United States. As late as
1859, nine years after the foundation of the college, the Philadelphia
County Medical Society passed resolutions of excommunication against
every physician who should teach in the school, every woman who should
graduate from it, and everybody else who should even consult with such
teachers.
Had the tiny college been a virulent pest-house, the _cordon sanitaire_
could not have been more rigidly drawn around it. Nevertheless, the
trustees claimed that their graduates rapidly secured medical practice,
at least to the extent of a thousand dollars a year; and that
applications were frequently received from communities in different
parts of the country, requesting that women physicians be sent to settle
among them.[74] In 1857 115 students had matriculated at the college.
In 1859 Elizabeth Blackwell estimated that about 300 women had managed
to “graduate” somewhere in medicine, supposing that their studies had
really “qualified them to begin practice, and that by gaining experience
in practice itself, they would gradually work their way to success.” “It
is not until they leave college, and attempt their work alone and
unaided, that they realize how utterly insufficient their education is
to enable them to acquire and support the standing of a physician. Many
of them, discouraged, having spent all their money, abandon the
profession; a few gain a little practical knowledge, and struggle into a
second-rate position.”
This view of the realities of the situation is in curious contrast with
the cheerful optimism of the leaders of the Philadelphia School. These
did indeed walk by faith,—and the numerous addresses of Ann Preston, who
for many years was its guiding spirit, breathe a spirit of moral
enthusiasm which, as the final result proved, really did manage to
compensate for the intellectual inadequacy. Dr. Preston seems to have
been thoroughly convinced, that if the moral behavior of the new
physicians were kept irreproachable, intellectual difficulties would
take care of themselves, or be solved by an over-ruling Providence.[75]
The fifth period for women physicians began with the founding of
hospitals, where they could obtain clinical training, and thus give some
substance to the medical education they had received in mere outline.
The oldest of these institutions is the New York Infirmary, chartered,
as has been said, in 1854 as a dispensary,—opened with an indoor
department in 1857, with the Drs. Blackwell and Zakzrewska as attending
physicians. The Infirmary was fortunate in securing several eminent New
York physicians as consultants, Dr. Willard Parker, Dr. Kissam, Dr.
James B. Wood, Dr. Stephen Smith, and Dr. Elisha Harris. The medical
profession in New York never took the trouble to organize opposition and
pronounce the decrees of ostracism that thundered in Philadelphia; its
attitude was rather that of indifference than active hostility.
From 1857 until 1865, the indoor department of the Infirmary was limited
to a single ward for poor lying-in women, and which contained but twelve
beds. But in the dispensary, several thousand patients a year were
treated, and the young physicians living in the hospital also visited
the sick poor at their own homes. The persevering efforts of the
Blackwells, moreover, finally succeeded in opening one medical
institution of the city to their students, the great Demilt dispensary.
As early as 1862, the succession of women students who annually pressed
forward to fill the two vacancies at the Infirmary patiently waited in
the clinic rooms of Demilt, and there gleaned many crumbs of experience
and information.[76] These, together with the practical experience
gained in the obstetrical ward and the out-practice of the Infirmary,
afforded the first and for a long time the only opportunity for clinical
instruction open to women students in America.
In 1865, a medical college was added to the Infirmary; a new building
was purchased for the hospital, which became enlarged to the capacity of
35 beds. For the first time it then began to receive private patients,
chiefly from among self-supporting women of limited income, to hundreds
of whom the resources of the Infirmary has proved invaluable. Their pay,
though modest, has contributed materially to the resources of the
hospital for the treatment of entirely indigent patients.[77]
The report for 1869 shows a hospital staff of: Resident physician, 1;
internes, 3; visiting physicians, 3; associate physicians, 3;
out-visiting physician, 1.
Total number in-patients, 342; Total number dispensary patients, 4825;
Total number patients treated at home, 768.
The Woman’s Hospital at Philadelphia was founded in 1862 during the
excitements of the great Civil War. It was the outgrowth of a singularly
brutal incident. In 1861 the resources of the college became entirely
exhausted; there was not enough money in the treasury to hire lecture
rooms, and it was reluctantly decided that the lecture course must be
suspended. Permission, however, had been obtained for the students to
visit the wards at the Blockley almshouse, and thither they went under
the tiny escort of Dr. Ann Preston. On one occasion, in order to
effectually disconcert the women students, one of the young men suddenly
introduced into the room a male patient perfectly nude. The insult stung
the friends of the college to renewed exertions, which were not relaxed
until funds were collected sufficient to purchase a house in which might
be opened a hospital where women could obtain clinical instruction by
themselves. A lecture room was rented in this house, and lectures were
resumed in the fall of 1862. From this date, the obstetrical chair of
the college, at least, was fairly supplied with clinical material. The
double institution, college and hospital, was first lifted out of its
period of depressing struggle, when, at the death of its generous
president, the Hon. Wm. S. Pierce, it received a bequest of $100,000.
With this, a really beautiful building was erected for the use of the
college.
Adjoining the college, soon sprang up a separate building for a general
hospital, which has, however, always been predominantly gynæcological.
Later was added a special maternity pavilion. The report of 1889 reads
as follows:
Hospital staff: Resident physicians, 1; internes, 6; visiting
physicians, 6; district physicians, 12; in-patients, 583;[78] dispensary
patients, 6365; patients treated at home, 695.
The woman’s hospital in Boston, the New England Hospital for Women and
Children, was also founded during the war, and incorporated in 1862. The
women who engaged in it were all heavily burdened by the great public
anxieties of the time. But the very nature of these anxieties, the keen
interest aroused in hospital work and in nursing organizations, helped
to direct attention to the women’s hospitals. In New York, the first
meeting to consider the organization of nursing for the army was held in
the parlors of the Infirmary, and at the suggestion of Elizabeth
Blackwell. This little meeting was the germ from which subsequently
developed the splendid organization of the Sanitary Commission.
Dr. Zakzrewska was invited by the founders of the New England Hospital
to preside over its organization;[79] and to do this, she left the
Female Medical School, with which great dissatisfaction was beginning to
be felt. Dr. Zakzrewska received powerful assistance for the work from
one of the graduates of the school, Lucy Sewall, descendant of a long
line of Puritan ancestors. This young lady seemed to have been the first
girl of fortune and family to study medicine in the United States. Her
romantic and enthusiastic friendship formed for Dr. Zakzrewska, while
yet her pupil, led the young Boston girl to devote her life, her
fortune, and the influence she could command from a wide circle of
friends, to building up the hospital, where she might have the privilege
of working with her.
This element of ardent personal friendship and discipleship is rarely
lacking in woman’s work, from the day—or before it—that Fabiola followed
St. Jerome to the desert, there to build the first hospital of the Roman
Empire.
Other pupils of the rudimentary Gregory school also felt the magnetism
of Dr. Zakzrewska’s personal influence, and entered a charmed circle,
banded together for life, for the defense of the hospital,—Anita Tyng,
Helen Morton, Susan Dimock, the lovely and brilliant girl whose tragic
death in the shipwreck of the _Schiller_, in 1875, deprived the women
physicians of America of their first surgeon. Dr. Morton spent several
arduous years in the Paris Maternity, where she became chief assistant
in order to fit herself for the medical practice at home in which she
has so well succeeded. Dr. Dimock went to Zurich, and was the first
American girl to graduate from its medical school. In the three brief
years that she was resident physician at the New England Hospital, she
exhibited a degree of surgical ability that promised a brilliant
professional career. The three surgical cases published by her in the
New York _Medical Record_ (see Bibliographical List) are of real
importance and originality.[80]
The New England Hospital, like its sister institutions at New York and
Philadelphia, outgrew, and more rapidly than they, its early narrow
limits in Pleasant Street, and in 1872 the present beautiful little
building was erected in the suburbs of Boston. The work was steadily
enlarged, year by year. The report for 1889 shows:
Hospital staff: Resident physician, 1; advisory physicians, 3; visiting
physicians, 3; visiting surgeons, 3; internes, 6. In-patients for year,
376; Dispensary patients, 3175.
In 1865, a fourth hospital for women and children was organized in
Chicago, “at the request and by the earnest efforts of Dr. Mary H.
Thompson, the pioneer woman physician in the city. Opened just at the
close of the war, many of those to whom it afforded shelter, nursing,
and medical attendance were soldiers’ wives, widows, and children, and
women whose husbands had deserted them in hours of greatest need. There
came from the South refugees both white and colored.”[81] Thus in the
West as in the East, we find repeated for the women physicians of the
nineteenth century the experience of the men of the eighteenth; it was
amidst the exigencies of a great war that their opportunities opened,
their sphere enlarged, and they “emerged from obscurity” into the
responsibilities of recognized public function.
In 1871, just as money had been collected to purchase a better house and
lot for the small hospital, the great fire occurred; and when after it,
“the remnants were gathered together, they were found to consist of one
or two helpless patients, two housemaids, a nurse, a pair of blankets,
two pillows, and a bit of carpet.”[82] The hospital “remnant,” however,
profited with others by the outburst of energy which so rapidly repaired
misfortune and rebuilt the city. In 1871, a building was purchased by
the Relief and Aid Society, for $25,000, and given to the hospital, on
conditions, one of which was that it should annually care for
twenty-five patients free of charge.
During the first nineteen years of its existence, up to 1854, over
15,000 patients had been cared for by the hospital, of which 4774 were
house patients, 9157 were treated in the dispensary, and 1404 attended
at home. The report of the hospital for 1888 gives a summary for four
years.[83] There is a hospital staff, comprising attending physicians,
5; pathologist, 1; internes, 3. Annual average from four years summary:
in-patients, 334; dispensary, 806; visited at home, 138.
The fifth woman’s hospital was opened in San Francisco in 1875, under
the name of the Pacific Dispensary, by Dr. Charlotte Blake Brown and Dr.
Annette Buckle, both graduates of the Philadelphia school. During the
first year, it contained but six beds. To-day, after fifteen years’
untiring work, the enlisted sympathies of generous friends have
developed it to a hospital for 110 beds, to which sick children are
admitted gratuitously, and adult female patients on payment of a small
charge. It is under the care of six attending physicians, who serve in
rotation.
Finally, in distant Minneapolis, a sixth hospital has sprung up in 1882.
At its latest report, only 193 patients had been received during the
year. But the history of its predecessors, and the irresistible Western
energy of its friends, predict for this a growth perhaps even more rapid
than that possible in cities in the East.
It is worth while to summarize the actual condition of these six
hospitals in a tabulated form:
═══════════════╤═══════╤═════╤═══════════════╤══════════╤═══════════╤═════════
NAME. │DATE OF│CAPA-│ NO. ON STAFF. │ANNUAL NO.│ANNUAL NO. │ ANNUAL
│ORIGIN.│CITY.│ │ IN- │DISPENSARY.│NO. OUT-
│ │ │ │PATIENTS. │ │PATIENTS.
───────────────┼───────┼─────┼───────────────┼──────────┼───────────┼─────────
New York │ 1857 │ 35│3 visiting │ 342 │ 4,825│ 768
Infirmary. │ │ beds│ physicians. │ │ │
„ │ │ │3 internes, 3 │ (report │ │
│ │ │ associates. │for 1889) │ │
„ │ │ │1 resident. │ │ │
„ │ │ │1 out- │ │ │
│ │ │ physician. │ │ │
───────────────┼───────┼─────┼───────────────┼──────────┼───────────┼─────────
Woman’s │ 1862 │ 47│6 visiting. │ 583 │ 6,365│ 695
Hospital, │ │ beds│ │ │ │
Philadelphia.│ │ │ │ │ │
„ │ │ │6 internes. │ (report │ │
│ │ │ │for 1889) │ │
„ │ │ │1 resident. │ │ │
„ │ │ │12 district. │ │ │
───────────────┼───────┼─────┼───────────────┼──────────┼───────────┼─────────
New England │ 1863 │ 58│6 visiting. │ 376 │ 3,175│
Hospital. │ │ beds│ │ │ │
„ │ │ │6 advisory. │ (report │ │
│ │ │ │for 1889) │ │
„ │ │ │6 internes. │ │ │
───────────────┼───────┼─────┼───────────────┼──────────┼───────────┼─────────
Woman’s │ 1865 │ 80│5 visiting. │ 354 │ 806│ 138
Hospital, │ │ beds│ │ │ │
Chicago. │ │ │ │ │ │
„ │ │ │3 internes. │ (average │ │
│ │ │ │ of │ │
│ │ │ │collective│ │
│ │ │ │report for│ │
│ │ │ │ 4 years) │ │
„ │ │ │1 pathological.│ „ │ │
───────────────┼───────┼─────┼───────────────┼──────────┼───────────┼─────────
Hospital for │ 1875 │ 110│6 attending. │ │ │
Sick Children│ │ beds│ │ │ │
and Women, │ │ │ │ │ │
San │ │ │ │ │ │
Francisco. │ │ │ │ │ │
„ │ │ │2 specialists. │ │ │
„ │ │ │2 internes. │ │ │
───────────────┼───────┼─────┼───────────────┼──────────┼───────────┼─────────
Northwestern │ 1882 │ │4 visiting. │ 193 │ │
Hospital, │ │ │ │ │ │
Minneapolis. │ │ │ │ │ │
„ │ │ │ │ (report │ │
│ │ │ │for 1889) │ │
───────────────┴───────┴─────┴───────────────┴──────────┴───────────┴─────────
Thus, total number of women physicians engaged in six hospitals, 94;
number renewed annually, 32; annual number indoor patients, 1828; annual
number of dispensary patients, 15,171; annual number patients treated at
home, 1601; total number patients, 18,600.
This represents the growth since 1857, when the only hospital conducted
by women, in this country, was the lying-in ward of the New York
Infirmary, containing twelve beds.
The foundation of these hospitals effected the transition for women
physicians from the pre-medical period, when medical education was
something attempted but not effected, to a truly medical epoch, when
women could really have an opportunity to engage in actual medical work.
Correlatively the theoretic education began to improve. In Boston, the
Female Medical College was happily extinguished as an independent
institution. In Philadelphia, the Faculty gradually struggled free of
its inefficient or objectionable members, utilized its legacy of
$100,000 to fully equip its beautiful college building, with
amphitheatres, lecture rooms, and even embryo laboratories, museums, and
libraries,—enlarged its corps of instructors until they numbered
twenty-three, instead of the original and meagre seven,—and even, though
more timidly, began to enforce something like a rigid discipline among
its students, in regard to conditions of admission, examination,
graduation, and terms of study. In 1885, Lawson Tait, the famous English
surgeon, described the college building as “being very large and
splendidly appointed. Last year twenty-six degrees of doctor of medicine
were granted by the Faculty, and from the perusal of the curriculum, as
well as from conversation with some of the graduates, and from
discussion with both the friends and opponents of the school, I am quite
satisfied that its graduates are quite as carefully trained as those in
any other medical school. When I tell you that last winter 132 students
matriculated in this school, that the amphitheatre in the hospital is
large enough to seat 300 persons, and that every year about 4000
patients pass through this amphitheatre in the college clinics, I shall
have said enough to prove to you that in the United States the practice
of medicine by women has become an accomplished fact.”[84]
In New York, after much hesitation, a charter was obtained in 1865 for
the establishment of a medical college in connection with the Infirmary.
“This step was taken reluctantly, because the desire of the trustees of
the Infirmary, of Drs. Elizabeth and Emily Blackwell, was not to found
another medical school, but to secure the admission of women to the
classes for instruction already organized in connection with the medical
charities of the city, and to one at least of the New York medical
colleges.... The demand of women for a medical education had resulted in
the founding of small colleges in different places, all, with the
exception of the Philadelphia School, limited to the narrow and cheap
standard of legal requirements, and producing equally cheap and narrow
results in the petty standard of medical education they were
establishing among women students.[85] Application was made to the
College of Physicians and Surgeons for advice, and the case was laid
before the Faculty. It was stated that a sufficient number of women were
studying medicine to show that there was a demand for instruction that
must be satisfied; that the standard of education was so low that
incompetent women were in possession of degrees, while competent women
could not obtain the thorough instruction they desired, and those who
were fitted to do good work had to contend, not only against popular and
unjustified prejudice, but against the justified prejudices of those who
saw the slipshod work of ignorant graduates from women’s medical
colleges.”[86] The trustees proposed to the College of Physicians and
Surgeons, the oldest and most reputable in New York, that they receive a
limited number of female students on scholarships established by the
Infirmary, to the amount of $2000 a year. This proposition was rejected,
and the opinion expressed, in no unfriendly spirit, that the ends
proposed were only to be obtained by establishing an independent school
for women in connection with the Infirmary.
The establishment of such a school called for money,—but the money was
forthcoming. A new building was purchased for the hospital; the old one,
which had done such modest but effective work, was surrendered to the
use of the college, and a prospectus issued announcing the requirements
of the latter. In this prospectus a bold attempt was made to outline a
scheme of education, which should not only satisfy the conventional
existing standard, but improve upon this. It was realized, and, oddly
enough, for the first time, that the best way to compensate the enormous
disadvantages under which women physicians must enter upon their work,
was to prepare them for it with peculiar thoroughness. Women students
were almost universally deficient in preliminary intellectual training:
their lesser physical strength rendered a cramming system more often
dangerous to health, and more ineffective as a means of preparation; and
the prejudices to be encountered in their medical career would subject
them not only to just, but also to abundant unfair criticism. Instead,
therefore, of the senseless official system which then everywhere
prevailed, it was proposed to establish a three years graded course,
with detailed laboratory work during the first years, and detailed
clinical work during the last. A chair of hygiene was established for
the first time in America, and an independent board of examiners was
appointed consisting of professors from the different city schools. By
this means the college voluntarily submitted itself to the external
criticism of the highest local authorities. When the Infirmary put forth
this prospectus, drawn up by the Drs. Blackwell, no college in the
country required such a course: it was deemed Quixotic by many medical
friends, and several of its features were for a time postponed. The
independent board of examiners, however, was established from the
beginning, and, little by little, the other parts of the scheme were
realized. In 1876, the three years graded course, at first optional, was
made obligatory. At this time no college but Harvard had taken this
step. The next year the class fell off one-third,—a curious commentary
on the character or circumstances of the students.[87] In 1881, the
college year was lengthened to eight months, thus abandoning the
time-honored division of a winter and spring course, the latter
comparable to the Catholic works of supererogation, and equally
neglected. At the same time entrance examinations were established.
These moderate improvements upon the naïve barbarism of existing customs
again reduced the classes one-half. When people first began to think of
educating women in medicine, a general dread seemed to exist that, if
any tests of capacity were applied, all women would be excluded. The
profound skepticism felt about women’s abilities, was thus as much
manifest in the action of the friends to their education as in that of
its opponents. But by 1882, the friends dared to “call upon those who
believe in the higher education of women, to help to set the highest
possible standard for their medical education; and upon those who do not
believe in such higher education to help in making such requirements as
shall turn aside the incompetent,—not by an exercise of arbitrary power,
but by a demonstration of incapacity, which is the only logical, manly
reason for refusing to allow women to pursue an honorable calling in an
honorable way.”[88]