served for a year at the Willard Asylum for the chronic insane,[135] and
in 1888, two other women, Dr. Steadman and Dr. Wakefield, were appointed
in the New York City Asylum on Blackwell’s Island. Similar appointments
have been voluntarily made in ten other States, and more than twenty
women are now serving as physicians in insane asylums.[136] The latest
appointment was the greatest innovation, for it was in a Southern State,
Virginia, at Staunton, and a Southern candidate, Miss Dr. Haynes, was
appointed.[137] The _Springfield Republican_ concludes its notice of
this event (see note), with the remark: “This reform is steadily
advancing, and it will not be long before the opposition to it will be
as obsolete as it is now indecent.”[138]
Thus the last word, (so far) like the first in this long controversy, is
indecency. And it is characteristic of the world-old social position of
women that it should be so; since women have in the mass, never been
publicly and officially regarded as individuals, with individual rights,
tastes, liberties, privileges, duties, and capacities, but rather as
symbols, with collective class functions, of which not the least was to
embody the ideals of decorum of the existing generation, whatever these
might happen to be. These ideals once consigned to women, as to crystal
vases, it became easier for men to indulge their vagrant liberty, while
yet leaving undisturbed the general framework of order and society. But
all the more imperative was it, that the standard of behavior, thought,
and life for women should be maintained fixed and immovable. Any symptom
of change in the status of women seems, therefore, always to have
excited a certain terror. This is analogous to the fierce conservatism
of savage communities, ready to punish by death the slightest deviation
from established custom, because, as Mr. Bagehot observes, without such
strenuous care their entire social structure is liable to fall to
pieces. It is perfectly evident from the records, that the opposition to
women physicians has rarely been based upon any sincere conviction that
women could not be instructed in medicine, but upon an intense dislike
to the idea that they should be so capable. Failure could be pardoned
them, but—at least so it was felt in anticipation—success could not.
Apart from the absurd fear of pecuniary injury, which was only
conceivable so long as women were treated, not as so many more
individuals in the community, but as a separate class, and a class alien
to men of their own race and blood and even family,—apart from this
consideration, the arguments advanced have always been purely
sentimental. There has always been a sentimental and powerful opposition
to every social change that tended to increase the development and
complexity of the social organism, by increasing the capacities and
multiplying the relations of its members. The opposition to women
physicians is, in its last analysis, only one of the more recent
manifestations of this universal social instinct. So true is this, that
in the strife physicians have abandoned the sentiments proper to their
own profession, and have not hesitated to revile and defame it, in order
to prove that it was unfit for the delicacy or virtue of woman. They
have forgotten the tone of mind, the special mode of vision that becomes
habitual to every one who has really crossed the threshold of the
sublime art; they have talked of “revolting details” and “disgusting
preliminaries,” like the veriest outside Philistine. There are horrors
in medicine, because there are horrors in life. But in medicine these
are overcome or transformed by the potency of the Ideal; in life they
must be borne unrelieved. The women, who, equally with men, are exposed
in life to the fearful, the horrible, the disgusting, are equally
entitled to access to those regions of knowledge and ideas, where these
may be averted, or relieved, or palliated, or transformed.
Again: A mother occupied with her young child offers a spectacle so
beautiful and so touching, that it cannot fail to profoundly impress the
social imagination. Contemplating this, it is easy to feel that all the
poetry and romance, all the worth and significance of women are summed
up in the exquisite moments of this occupation; easy to dread the
introduction of other interests lest the women be unduly diverted from
this, which is supreme. Yet nothing is more obvious than that diversion
comes, a thousand times, from frivolity, but never through work; and
that these moments are preceded by many years, and followed by many
years, and for many women, through no fault of their own, never come at
all. The seventy years of a life-time will contain much waste, if
adjusted exclusively to the five or six years of even its highest
happiness. The toiling millions of women of every age of the world have
not been permitted to make such an adjustment, even if they should wish
to do so. They have always worked; but they demand now, and simply, some
opportunity for a free choice in the kind of work, which, apart from the
care of children, they may perform. The invasion of the medical
profession is one of the more articulate forms of this demand.
Although, according to the census of 1880, there were 2432 women
registered as physicians throughout the United States, and several
hundred must have graduated in the last ten years, it is probable that
many of them have received an education too irregular and imperfect to
justify their claim to the title in any serious sense. Thus the numbers
are still too small, the time too short, to begin to estimate the work
of women physicians. A large number of the women recorded in the census
tables will not be found among the graduates of any suitable colleges,
or on the registered lists of regular physicians, and these cannot be
counted in an estimate like the present. Thus the census of 1880 records
133 women physicians in New York, but the medical register of ten years
later contains the names of but 48. There seem to be about fifty at
present in Philadelphia, twenty or thirty in Boston. Eighteen are said
to be practicing in Detroit. The great majority are scattered through
the country in small towns or country villages.
It is irrelevant to inquire with Waldeyer, “What women have done?” from
the scientific standpoint, because the problem given was to enable them
to become observant, faithful, and skillful practitioners of medicine,
and this is possible without the performance of any really scientific
work.
It is premature to make such inquiries, except for single cases which
serve to illustrate the possibility, for it is but little more than a
generation that the first school was opened to women; it is not more
than a dozen years since the official education attainable has
approached any degree of effectiveness. What women have learned, they
have in the main taught themselves. And it is fair to claim, that when
they have taught themselves so much, when they have secured the
confidence of so many thousand sick persons, in the teeth of such
vigorous and insulting opposition, and upon such scanty resources and
such inadequate preparation; when such numbers have been able to
establish reputable and even lucrative practice, to care for the health
of many families over long terms of years, to sustain medical
institutions of their own, almost exclusively dependent upon the
good-will of citizens who have closely watched their work,—to serve in
public hospitals in competition with men, to care for many thousands of
sick poor, to whom abundant other medical aid was accessible, had it
been preferred,—to restore to health many thousand women who had become
helpless invalids from dread of consulting men physicians, or from delay
in doing so,—to hold their own in private practice, in matters of
judgment, diagnosis, medical and operative treatment, amidst the
incessant and often unfair rivalry of brother competitors,—to do all
this, we repeat, itself demonstrates a very considerable, indeed an
unexpected amount of native ability and medical fitness on the part of
women. With longer time, with more solid and varied opportunities, and
with extension to the many of those which have hitherto been shared only
by a very few, the amount of work accomplished may certainly be expected
to increase, and in geometrical progression.
It could be wished that space remained to bring to light the obscure
heroisms of the many nameless lives, which have been expended in this
one crusade. It has been fought, and modestly, in the teeth of the most
painful invective that can ever be addressed to women,—that of
immodesty. Girls have been hissed and stampeded out of hospital wards
and amphitheaters where the suffering patient was a woman, and properly
claiming the presence of members of her own sex; or where, still more
inconsistently, non-medical female nurses were tolerated and welcomed.
Women students have been cheated of their time and money, by those paid
to instruct them: they have been led into fields of promise, to find
only a vanishing mirage. At what sacrifices have they struggled to
obtain the elusive prize! They have starved on half rations, shivered in
cold rooms, or been poisoned in badly ventilated ones; they have often
borne a triple load of ignorance, poverty, and ill health; when they
were not permitted to walk, they have crept,—where they could not take,
they have begged; they have gleaned like Ruth among the harvesters for
the scantiest crumbs of knowledge, and been thankful. To work their way
through the prescribed term of studies, they have resorted to
innumerable devices,—taught school, edited newspapers, nursed sick
people, given massage, worked till they could scrape a few dollars
together, expended that in study,—then stepped aside for a while to earn
more. After graduating, the struggle has continued,—but here the
resource of taking lodgers has often tided over the difficult time.
These homely struggles,—the necessity in the absence of State aid, of
constantly developing popular support and sympathy for the maintenance
of the colleges and hospitals, has given a solidity, a vitality to the
movement, which has gone far toward compensating its quaint inadequacies
and inconsistencies. On the European continent, the admission of women
to medical schools has depended on the fiat of government bureaus,
prepared in this matter to anticipate a popular demand, and to lead
rather than to follow public opinion. In America, as in England, the
movement for such extension of privilege has sprung from the people, it
has fought its way,—it has been compelled to root itself in popular
sympathy and suffrage. Hence a feeling of enthusiasm widely diffused
among the women students, the sense of identification with an impersonal
cause, whose importance transcended that of their individual personal
fortunes, and yet which could only be advanced by the accumulation of
their individual successes. The ill-taught girls at Chicago, who, sure
in advance of defeat, resolved to face ridicule and contempt at the
competitive examinations, in order to make a road for their successors,
really exhibited, in a moral sphere, the heroism of Arnold Von
Winklereid on the old Swiss battlefield.
The change from the forlorn conditions of the early days has been most
rapid, and those who survived the early struggle, and whose energies
were not so absorbed by its external difficulties that not enough were
left for the intrinsic difficulties of medicine, have been really
invigorated by the contest. Indeed one of the ways in which women have
secured the infusion of masculine strength essential to their success,
has been by successfully resisting masculine opposition to their just
claims. It is as in the fable of Antæus,—those knocked down to the earth
gained fresh strength as they touched the ground. The character and
self-reliance natural to American women have thus been reenforced even
by the adverse circumstances of their position. And, conversely, those
for whom circumstances of fortune and education have been apparently the
most propitious, even those who have received the best theoretical
education, have not unfrequently been distanced, or even dropped
altogether out of the career, because of an incurable dilettantism, for
which the remedy had not been found either in practical hardship or in
native intellectual vigor.
Efforts have several times been made to estimate the actual proportion
of markedly successful practitioners among the women now engaged in
medicine.[139] The two monographs cited below are both based upon
circulars of questions sent out to as many women physicians as
possible.[140] The answers to these inquiries are necessarily very
partial, and can be quoted rather as illustrations than as statistics.
Among such illustrations, the statements of the pecuniary results of
practice are interesting. Dr. Bodley received answer from 76 ladies, and
their total annual income, if divided equally among the 76, amounted to
about $3000.[141] Among these, however, ten earned between $3000 and
$4000 a year, five between $4000 and $5000, three between $5000 and
$15,000, and four between $15,000 and $20,000.
In Dr. Pope’s paper, 138 women reported on their income, and out of them
only eleven had then practiced over two years and failed to become
self-supporting. Another item of interest is, that 32 per cent. of these
women report that they have one or more persons partially or wholly
dependent on them.[142]
So great are the imperfections, even to-day, of the medical art, so
numerous all the difficulties of applying even all existing resources,
so inevitable are the illusions in regard to the real cause of either
success or failure, that it is the most difficult thing in the world to
estimate the intrinsic ability of a physician, even by his success in
practice. A large practice certainly always testifies to some kind of
ability; but this is not always strictly medical. The essential test is
that of accuracy in diagnosis, and this test cannot, by means of any
public documents accessible, be applied. Its successful application can
only be inferred by the gradual development of confidence in women, both
among the more intelligent and critical of the laity, and among the more
unbiassed of the professional observers, who, in consultations, have had
ample opportunity to scrutinize diagnoses.[143] For a dozen years it has
become customary in America for the most distinguished members of the
profession, even in large cities, to send patients to women physicians,
in any case where the circumstances of the illness lead the patient to
prefer a woman.[144] The same is done when, from personal acquaintance,
or on account of public reputation, the patient has confidence in some
special woman physician, and desires her counsel therefore, for other
reasons than those of delicacy.
The women physicians of America share, while rather intensifying, the
main characteristics of their medical countrymen. They have, as a rule,
little erudition; but they have great capacity for bringing to bear all
available and useful knowledge upon practical issues. They certainly do
not read enough; and there is, therefore, a noticeable thinness in their
discussions of medical topics when they meet in isolated council. But
they have a resolute helpfulness in dealing with the individual cases
entrusted to their care, and a passionate loyalty to those who have put
their trust in them. They are possessed of abundant motive power for
concrete intellectual action, though they might lack this power, if the
work depended exclusively on abstract intellectual interest. And, after
all, it is this habit of mind which most distinctively marks the modern
practicing physician, and without it the advances in medical science
would be of little profit to the sick; indeed, would often not be made.
And, what is often overlooked, it is precisely these mental habits here
described which have been usually considered as particularly
characteristic of women. Thus the introduction of women into medicine
demands no modification of the typical conception traditionally held of
women, but only an enlargement of the applications which may be made of
this characteristic type.[145]
In nothing are popular views about women more at variance with fact than
in regard to their capacity for operative surgery. The popular
conception of surgery is itself entirely false, being inherited from a
by-gone period, when hospital operations were conducted in the wards,
filled with shuddering patients awaiting their own fate; amid clouds of
steam from burning irons, torrents of blood, and the groans and shrieks
of the victim.[146] But to-day, with anæsthetics, hæmostatics, and
antiseptics, the surgeon may operate as calmly as on an insensible wax
figure; and, moreover, with a reasonably correct technique, be assured
of success in a vast majority of cases whose result was formerly, even
under the best skill, always doubtful. The very greatness of the
achievements of surgical genius have lessened the amount of ability
requisite to perform many surgical operations; and especially have the
modern conditions of operating removed the perturbating influences which
female nerves might be supposed unable to resist. Moreover, the
technique has become so precise that it can be taught; and women, even
when defective in power of original thought, are extremely susceptible
of being trained by exact drill. On this very account the model of a
practical medical school should be that of a military academy, where
every operation, mental or manual, that the graduate is subsequently
expected to perform, will be rehearsed before graduation.
Now the remarkable thing about women surgeons is, not that they have
learned how to operate when they have been taught, but that, with very
insufficient teaching for the most part, they have contrived to learn so
much, and to operate so successfully. Obstetrics and gynæcology have
here again offered peculiar advantages, in presenting a series of cases
for operation which vary from the most trifling[147] to the most serious
capital operations in surgery. The latter have only been attempted in
the last decade, and it is worth while to quote such statistics as I
have been able to obtain, even though they are necessarily incomplete:
New York Infirmary: From 1875 to 1890; 535 operations (29 laparotomies);
operators, chiefly Dr. Elizabeth Cushier, but in a smaller number of
cases, Drs. Blackwell, Peckham, McNutt, Putnam Jacobi.
New England Hospital: From 1873 to 1890; 829 operations (48
laparotomies); operators, Drs. Dimock, Buckel, Keller, Berlin, Whitney,
Smith, Crawford, Bissell, Kellogg, Angell, Pagelson.
Chicago Hospital: From 1884 to 1888; 206 gynæcological, 114 general
surgery. Dr. Mary Thompson operated on all the gynæcological cases,
except four; the report does not state whether she also operated on the
others.
The reports of the Philadelphia Hospital do not give the total number of
operations performed in it, but through the kindness of Dr. Fullerton,
resident physician, I have received a report of the capital operations,
nearly all abdominal:
Women’s Hospital, Philadelphia: From 1876 to 1889; 91 operations (all
laparotomies, including several Cæsarean sections). Operators, chiefly
Dr. Anna Broomall; for a small number of cases, Drs. Croasdale and
Fullerton.[148]
In addition to the above, Dr. Marie Werner of Philadelphia reports 23
laparotomies from private practice.
Other personal statistics I have not been able to obtain. Some are
quoted in the list of Literature.[149] These statistics, though still on
a small scale, are, for the time in which they have accumulated, and for
the extremely meagre opportunities which have been so far afforded, not
at all unsatisfactory.
Written contributions to medical literature are also, though not
abundant, at least sufficient to prove that “the thing can be done.” The
145 citations made in the list[150] all belong to the period ranging
between 1872 and 1890, a period of eighteen years.
The intellectual fruitfulness of this period is not to be compared with
that exhibited by other and contemporary classes of medical workers, but
rather with that of the first 150 or 200 years of American medicine.
For, until now, it is a mentally isolated, a truly colonial position,
which has been occupied by the women physicians of America. When a
century shall have elapsed after general intellectual education has
become diffused among women; after two or three generations have had
increased opportunities for inheritance of trained intellectual
aptitudes; after the work of establishing, in the face of resolute
opposition, the right to privileged work in addition to the drudgeries
imposed by necessity, shall have ceased to preoccupy the energies of
women; after selfish monopolies of privilege and advantage shall have
broken down; after the rights and capacities of women as individuals
shall have received thorough, serious, and practical social recognition;
when all these changes shall have been effected for about a hundred
years, it will then be possible to perceive results from the admission
of women to the profession of medicine, at least as widespread as those
now obviously due to their admission to the profession of teaching.
NOTE.—While these pages are passing through the press, the important
announcement is made that the trustees of the Johns Hopkins
University—in view of a gift of $100,000, presented by women to the
endowment fund of the medical department,—have consented to admit
women to the medical school of the Johns Hopkins Hospital, so soon as
that school shall be opened. This is the first time in America that
any provision for the medical education of women has been made at a
university of the standing of the Johns Hopkins. It is expected that
the medical education of the future school will be especially directed
for the benefit of selected and post graduate students, for such as
desire to make special researches and to pursue advanced studies in
medical science. The admission of women to a share in these higher
opportunities is a fact of immense significance, though only a few
should profit by the advantage, the standing of all will be benefited
by this authoritative recognition of a capacity in women for studies,
on this higher plane, on equal terms and in company with men.
The directors of the Johns Hopkins have in this matter shown the broad
and liberal spirit which befits the noble trust they are called upon to
administer. It is characteristic of America that the stimulus to the
trustees’ action came from without the university, from the initiative
of women. This time, women have not only asked but they have at the same
time given. The $10,000 gift originally offered by Miss Hovey to Harvard
on condition of its admitting women, and declined by its medical
faculty, has been enrolled in the gift now accepted by the Johns
Hopkins. Half of the whole donation is the noble gift of one woman, Mary
Garrett,—daughter of one of the original trustees of the Johns Hopkins
University. The formation of committees among women in all the principal
cities of the United States, for the purpose of raising money for the
woman’s part of the endowment fund, and even for the remaining amount
needed to open the school, is itself a most important fact, for it
indicates that interest in the intellectual advancement of women, and
especially interest in the success of women in the medical profession,
has at last become sincere and widespread in quarters where hitherto it
has been entirely and strangely lacking.
Hardly had we pronounced the present position of women in medicine to be
“colonial,” when, by a sudden shifting of the scene, barriers have been
thrown down that seemed destined to last another half century; an entire
new horizon has opened before us. _Sic transit stultitia mundi._
VIII.
WOMAN IN THE MINISTRY.
BY
(REV.) ADA C. BOWLES.