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Honors Thesis Collection
2016
Reconciling Femininity and Professionalism:
Female Physicians in 19th Century America
Ayesha Anwar
[email protected]
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ReconcilingFemininityandProfessionalism:FemalePhysiciansin19thCentury
America
AyeshaAnwar
SubmittedinPartialFulfillment
ofthe
PrerequisiteforHonors
inHistory
May2016
copyright2016AyeshaAnwar
1
Acknowledgements:
Thisprojectwouldnothavebeenpossiblewithoutthesupportofmy
parents,friends,andofcourse,myadvisor,ProfessorRyanQuintana.Youbelieved
inme,oftenwhenIdidn’tbelieveinmyself.Tomymotherandfather,wholistened
tomerambleonandonaboutthedifficultyofwritingathesisasiftheyweren’t
savingliveseveryday.IwouldalsoliketothanktheSchwarzFoundation,for
fundingmytraveltodifferentarchives.Theexperienceofdoingarchivalresearch
wasincrediblyvaluableinmyworkonthisproject,aswellasbeingvaluableinand
ofitself.TothelibrariansandarchivistsatthearchivesIvisited—TheSUNYUpstate
MedicalUniversity,theNationalLibraryofMedicine,andtheWellcomeCollection—
thisprojectwouldnotbepossiblewithoutyourhelp.
TotheentirehistorydepartmentatWellesleyCollege—fromyouIlearned
howtostudyhistory,howtoexaminedifferentsocietiesatdifferenttimesandfind
commonalities,whilebeingconsiderateofnuanceanddifference.FromyouI
learnedhowtolearnhistory,howtodiscussanddebateanddecidewithoutoffense.
FromyouIlearned,finally,howtowritehistory,howtogiveofmyselfinmywork,
howtogiveofmyopinions,howtotakemyunderstandingofthewaysinwhichthe
worldworked,andhowtoapplythatunderstandingtothespecificquestionsI
soughttoaddress.
AndtoMr.FrankO’Brien,withoutwhomImayneverhaveembarkedupon
thestudyofhistory,andmylifewouldundoubtedlybethepoorerforit.
2
Introduction:
ElizabethBlackwell,British-bornbutAmerican-raised,wasinhertwentiesand
searchingforausefuloccupation.Herfamilywasfinanciallysecurethankstothe
herandhersisters’jointeffortsaftertheirfather’sdeath,butBlackwelldidn’twish
tomarry,didn’tenjoyteaching,andwastooactivetostayathome.Shevisiteda
familyfriendoneday,awomanwhowasdyingaslow,painfuldeathof“adisease,
thedelicatenatureofwhichmadethemethodsoftreatmentaconstantsufferingfor
her.”“’If I could have been treated by a lady doctor, my worst sufferings would have
been spared me.’” she told Blackwell.1 Blackwell, despite detailing her own initial
revulsion to the human body, became fixed on the idea. She was the first woman to earn
an MD in the United States, graduating from Geneva Medical College of Syracuse, New
York in 1848.
Following her graduation from medical school, Blackwell went on to study in France
and England, before returning to the United States to practice, eventually opening her
own hospital. She went on to offer postgraduate training for women physicians and
nurses and in time opened a medical school attached to the New York Infirmary. She
would later follow one of her students to England, where she would be the first woman
on the British medical registry, and help found the first British women’s medical college.
Blackwell’s friend’s story was not a unique one. The rise of professionalism meant
that increasingly men were responsible for healthcare, including reproductive care and
midwifery. The convergence of this pattern with the rise of Victorian ideals and societal
1Blackwell,Elizabeth.PioneerWorkinOpeningtheMedicalProfessiontoWomen;Autobiographical
Sketches.NewYork:Longmans,Green,and,1895,58-59.
3
propriety meant that woman often chose not to tell male physicians about their illnesses
until it was too late. If only female patients could have had a confidante with more
knowledge than their mothers and friends… Female physicians answered this call to
action magnificently. Blackwell seemed to open the floodgates – within a decade there
were other women who earned their degrees by attending a male medical school, as well
as both male and female doctors who rapidly worked to create a system of female
medical education. One of the resulting institutions, the Women’s Medical College of
Philadelphia, was a worldwide leader in regular female medical education – its alumnae
included the first women physicians of Native American, African American, and
Japanese ancestry, as well as a medical missionary of American descent who lived in
India.2
Women physicians had a crucial role in not only providing healthcare to the female
population, but also in reclaiming the authority derived from scientific knowledge and
professional education, and in the use of this authority to influence not only response to
disease, but also child-rearing, pre- and post-natal care, and the physical and intellectual
education of women. While women had traditionally been responsible for nursing ill
family members, as well as working as midwives, increasing professionalization of
medicine and healthcare eliminated a lot of these avenues. Female physicians, by
undergoing the traditional path of education and training, were able to reclaim this
authority. In this thesis, I will study the medical education, public and professional
writings, and scientific contributions of these women, in order to gain a better
understanding of their role in reforming societal expectations for all women. Studying a
2Morantz-Sanchez,ReginaMarkell.SympathyandScience:WomenPhysiciansinAmericanMedicine.
NewYork:OxfordUniversityPress,1985.76.
4
relatively long time period, from 1848 to 1910, will allow for a more nuanced discussion
of the ways in which different generations of women physicians played off the results of
their predecessors and set the stage for their successors. I chose this specific period of
time as Blackwell received her M.D. in 1848, and 1910 marked the publishing of the
Flexner Report, which marked the end of the most pluralistic era of American medicine.
The Flexner Report called for a rigid adherence to science, and resulted in the closure of
most rural medical schools, most schools that did not follow strictly allopathic curricula,
and many schools that could not keep up with the expenses of the newest scientific
technology.3 In terms of my area of interest, this meant that many women’s medical
colleges were closed, and the rate of coeducation rose, and the openness of the
profession, which had allowed for a period of medical pluralism, gradually ended.
Flexner recommended increased government oversight and regulation of licensing
agreements as compared to the looser restrictions of the previous fifty years. The Flexner
Report resulted in massive shifts in the medical profession and its regulation, making its
publication a good point at which to conclude my study. There were a number of factors that made the medical profession particularly
accessible for women at this time. There was little oversight from the federal government
in regards to qualifications needed to become a physician. Instead, licensing requirements
varied from state to state, and educational requirements to enter a medical school varied
from institution to institution. Medical schools had ample financial motive to keep
educational requirements as low as possible, in order to encourage more students to
apply, and be accepted. This meant that entrance into a ‘traditional’ medical school was
3Hudson,RobertP.,andRonaldL.Numbers."AbrahamFlexnerinPerspective."InHealthand
SicknessinAmerica,editedbyJudithWalzerLevitt,148.2nded.Madison:UniversityofWisconsin
Press,1985.
5
comparatively easy for most men – it was considered that men who weren’t suited to any
other profession often found themselves in medicine.4
Furthermore, there were different avenues for attaining professional qualifications –
while one could only obtain an M.D. from successful graduation from a medical school,
many practitioners won their professional acknowledgment form completing an
apprenticeship. At this time, a multitude of medical ideologies were emerging and
developing, each competing for patients – hydropaths, homeopaths, advocates of herbal
medicines, and micro-dosages, among others. Some of these alternative ideologies were
more open to the admission of women practitioners.
Women physicians served an important role in demonstrating through their successes
that women were intellectually capable of higher education without negative
repercussions to their reproductive organs. The fact that many of them were married,
Mary Putnam Jacobi and Abraham Jacobi for example, proved that the pursuit of a career
would not automatically preclude a woman from filling the role society expected from
her – that of a wife and mother. Female physicians had to negotiate an interesting space –
on the one hand, they were occupying a masculine-dominated profession—furthermore
one that was notable in its gruesome nature and brute physicality, as well as aspects such
as nudity of both sexes, which was seen as explicit, and death. The necessary work on
cadavers was seen as grotesque, and dissection was something that ought to disgust the
proper lady, the woman that met societal standards of behavior. While women physicians
occupied this space, they also maintained a strong sense of feminine identity, often
rejecting radical social movements—Elizabeth Blackwell was once invited to speak at a
4Ibid.
6
women’s rights convention, but declined as she felt men had been too instrumental in her
development and career for her to denigrate them.5
Beyond redefining femininity by their actions, Blackwell and others also took up the
pen, using a newly garnered professional authority and respect for expertise to dictate to
the general public what femininity was by biological definition, and how it ought to be
treated by society. Blackwell pushed for more rigorous education for girls, and wrote to
describe how mothers could teach their adolescent daughters about sex.
This does not mean, however, that Blackwell was on the forefront of radical medical
ideology—she maintained that disease had moral causes rather than bacterial ones and
supported theories of eugenics; she opposed abortion and animal experimentation. Often
as part of maintaining a strict and non-threatening feminine presence, women physicians
frequently rejected theories and movements that could result in loss of support or public
discredit.
The evolution of science also plays a large role in the narrative that I am
investigating. The beginning of the time period I examine is marked by a grave
uncertainty in medicine, with societal faith in physicians at an all time low, following
news from Germany that the traditional treatments were not working in conjunction with
a failure to find more successful treatment options. By the end of the relevant time
period, we see the rise of statistical analyses, the increasing dependence on quantifiable
measurements such as blood pressure and heart rate, and a decreased reliance on visual
and qualitative data, as well as the emergence of fields such as microscopy, toxicology,
and bacteriology. The rise in science also widens the knowledge gap between the doctor
5Blackwell,Elizabeth.PioneerWorkinOpeningtheMedicalProfessiontoWomen;Autobiographical
Sketches.NewYork:Longmans,Green,and,1895,178-9.
7
and the patient, skewing the power dynamics of this relationship. As doctors grew more
powerful, their authority was more readily accepted, allowing women physicians who
may not have gained much traction from their male colleagues to gain ground with the
wider population.6
Chapter One seeks to analyze the importance of medical education, with a focus on
women’s medical schools in particular. I will be focusing on the Women’s Medical
College of Philadelphia, the Medical College of the New York Infirmary of Women and
Children (founded and overseen by Blackwell), and the New England Female Medical
College in Boston. How were these institutions affected by the pluralism of ideologies
that defined the medical profession in the nineteenth century? How were they received by
the public, and by their future male colleagues? How did the standards of learning at a
women’s medical college compare to those of a men’s medical college? I will go on to
explore the role increasing government oversight, as highlighted by the Flexner Report,
had on increased closings of female medical colleges. Finally, this chapter will examine
the status of female medical students in coeducational medical schools—while
coeducation was seen as the ultimate goal by many of the first generation of female
physicians, did it really reflect genuine equality amongst medical students and
professionals, regardless of gender?
Chapter Two seeks to investigate rhetorical strategies used by women physicians to
explain why they were needed, what they brought to the field, and to counteract
arguments made by their detractors. It first seeks to understand the arguments made
against women physicians. These arguments had either a physical or moral basis. Male
6Wells,Susan.OutoftheDeadHouse:Nineteenth-CenturyWomenPhysiciansandtheWritingof
Medicine.Madison:UniversityofWisconsinPress,2001.29.
8
physicians often said that women were not able to participate in medicine due to their
physical frailty, for example. A separate line of argument claimed that women were
unsuited for medicine due to their mental inability to think rationally. The popular
science of phrenology, based on the analysis of the skull, was able to intertwine physical
and mental aspects, as it dictated that development of certain areas of the skull resulted in
the augmentation or diminution of certain mental and moral capacities. Phrenology was
used by proponents and opponents of women physicians alike, and the differing
interpretations advocated for their perspectives.
Chapter Three seeks to look at the role women physicians played in the profession as
a whole. While many of the first wave of women physicians felt that their role was based
on feminine moral exceptionalism, others felt that they should participate in the field in
the same way that men did. Blackwell was a major proponent for maternalist medicine
and felt that it was the role of women physicians to morally police the development of
science. In opposition to her was Mary Putnam Jacobi, who felt that scientific evidence
and rational thought should be dominant over moral instinct. Additionally, this chapter
seeks to discuss the motivations women had for choosing to enter the profession. We will
also investigate the actual experiences women had as well, as opposed to their ideal
prescriptions. Finally, we will look at the ways in which women physicians used their
professional authority to reframe gender. Some non-white female physicians also utilized
their unique positions as intermediaries between the medical profession or the
government or the middle class and their marginalized racial groups. While most women
physicians at this time were white and middle-class, there were also a handful of black
women physicians and at least one Native American woman physician. At a time at
9
which white doctors often let black patients die of tuberculosis without substantial
treatment, due to the perception of increased susceptibility and weaker constitutions, how
did early black female doctors address the ways in which black patients, male and female,
were treated? Susan La Flesche Picotte was a physician and member of the Omaha tribe,
and used her social status to provide a new way to view Native American populations,
showing them as humanistic and civilized, while vocally opposing the means by which
whites sold Native American alcohol, despite the high rates of alcoholism in the
community.
Women continuously reified and subverted gendered expectations for their behavior.
They drew a line between what was radical and acceptable, in terms of the profession,
and what was radical and endangered the entire movement. By creating their own
medical institutions, they were able to support each other and foster the especially
feminine attributes they felt were crucially needed in the profession. By not refuting the
differences between men and women, they were able to use phrenological arguments to
justify their capabilities and their importance. By attaining professional authority, they
were able to reformulate notions of gender such that subsequent women found it less
difficult to enter the profession.
10
Chapter1:PreconditionsandPathwaysfortheEntranceofWomenintoMedicine:
NegotiatingWomen’sMedicalEducation
11
In1869,agroupofwomenfromtheWomen’sMedicalCollegeof
PhiladelphiafiledintoalecturehallatthePennsylvaniaHospitalinPhiladelphia,.
Thiswasnot,however,aninnocuousaddressonmedicalpractices,butinsteadalive
hospitallectureonfemoralfractures,completewithamalepatient.Thiswasthe
firstrecordedinstanceofwomenstudentsattendingclinicalclassesthatwere
usuallyattendedbymenonly.7Themomentaryexposureofthepatient’sthigh,in
ordertoexplainthebonehealingprocess,resultedinanoutcryfromthemale
students,wholaunchedatthewomen“missilesofpaper,tinfoil,tobacco-quids,
etc.”8Thewomenwhoreportedontheincidentnotedthelackofdecorumfrom
theirfellowstudents“whilesomeofthesemen(?)defiledthedressesoftheladies
nearthemwithtobaccojuice.”9Thisincidentbecameknowninthepressasthe
JeeringIncident,andwasdiscussedinlocalandregionalnewspapers.
Someofthenewspapereditorialsweredefensiveofthemalestudents,
claiming,“nopersoninfemaleattirewashissed,booed,orinsulted.”10Thesame
authormadethefurtherclaimthatthefemalestudents“infest[ed]therightsoffourhundredregularmedicalstudents,”11andlaterasked“Whoisthisshamelessherdof
sexlessbeingswhodishonorthegarbofladies?”12Reactingtowhattheysawasa
clearviolationofacceptablefemalebehavior,themeninquestionandtheir
7More,EllenS.,ElizabethFee,andManonPerry."Introduction:NewPerspectivesonWomen
PhysiciansandMedicineintheUnitedStates,1849toPresent."InWomenPhysiciansandtheCulture
ofMedicine,3.Baltimore,MD.:JohnsHopkinsUniversityPress,2009.
8Skinner,Carolyn.StudiesinRhetoricsandFeminisms:WomenPhysiciansandProfessionalEthosin
Nineteenth-CenturyAmerica.Carbondale,IL,USA:SouthernIllinoisUniversityPress,2014.Accessed
September12,2015.24.ProQuestebrary.WomenPhysiciansandProfessionalEthos.
9Marshall,Clara.TheWoman'sMedicalCollegeofPennsylvania:AnHistoricalOutline.Philadelphia,
Pennsylvania:P.Blakiston,1897.20.The(?)wasoriginaltotheprimarysource.
10
"PioneersintheFaceofAdversity:"TheMobof'69""January1,1869.AccessedDecember13,
2014.http://doctordoctress.org/islandora/object/islandora:1347
11Ibid.
12
Ibid.
12
supportersstrippedthewomenoftheirfemininity,toexcludethembothfromthe
feminineandprofessionaldomains,toportraythemasclearoutsiders,andas
violationsofthelawsofnature.
Numerouseditorialswrittenbyanonymousfemalestudentsdefendedtheir
righttoattendthelectureinpeace.13Interestingly,theseeditorialsoftenquestioned
thegentlemanlinessoftheharassers,inthesamewaythatsupportersofthemen
questionedthefemininityofthestudents.Whilebothgroupsquestionedeach
other’sadherencetogenderedexpectationsofbehavior,neitherquestionedthe
rigidityofthoseexpectations.Thisincidentallowsustounderstandthedifficulties
earlywomenmedicalstudentsinnineteenth-centuryAmericafacedina
coeducationallearningenvironment.Theyconfrontedisolation,exclusion,
harassment,andtheharshjudgmentofsociety.Itisclearthatwhilethesewomen
didchallengenotionsofgenderbyattendingthelectures,theydidnotfeelthatway,
andweredeeplydissatisfiedatbeingstrippedoftheirfemininity,whichtheyfelt
wascentraltotheirclaimsofmedicalexpertise.14
Earlyfemalemedicalcollegeswereplaceswherewomenmedicalstudents
couldobtainamedicaleducationwithoutattacksontheirfemininityortheir
adherencetopropriety.Earlyfemalemedicalstudentschallengedgender
boundaries,butoftendidsoinwaysthatreifiedperceivedgendernorms.Early
womendoctorsadheredtotheargumentthatclassicallyfemininetraitssuchas
13"Blackguardism."
Philadelphia Evening Bulletin, November 8, 1869. Accessed October 15, 2014.
http://doctordoctress.org/islandora/object/islandora:1347.
14Morantz-Sanchez,ReginaMarkell."SeparatebutEqual:MedicalEducationforWomen."In
SympathyandScience:WomenPhysiciansinAmericanMedicine,73.NewYorkCity,NY:Oxford
UniversityPress,1985.190.
13
empathyandcompassionwereinfactnecessaryattributesthatwomenbroughtto
medicine.ElizabethBlackwell,forexample,wasverycarefulinselectingstudents
forhermedicalschool–rejectinganyonewhoseemedtooradicalineithertheir
medicalbeliefsorsocialpersuasion.15JosephLongshore,oneofthefoundersofthe
Women’sMedicalCollegeofPhiladelphia,arguedthatwomenwerewellequipped
forthestudyandpracticeofmedicineduetothe“acutenessofherperception,
correctnessofherobservation,hercautiousness,gentleness,kindness,endurancein
emergencies,conscientiousnessandfaithfulnesstoduty.”16Examiningwhich
qualitieswomen’smedicaleducationsoughttoaccentuateanddiminishcanhelpus
gainabroaderunderstandingoftheprofessionalenvironmentandeducationof
earlywomenphysiciansintheUnitedStates.
Awoman’sintroductionintotheprofessionofmedicineonanindividual
levelwasinmedicalschoolortraining.Whilewomenhadforgenerationsstudied
medicinethroughapprenticeshipstobecomemidwivesandlaternursesand
homeopathicdoctors,Iwillbefocusingontheinstitutionofmedicalschool.17
Havingaformalmedicaleducationinamedicalcollegethatadheredtoemergent
nationalguidelineswasinstrumentalinthestruggletoearnlegitimacyforthese
15Morantz-Sanchez,ReginaMarkell."SeparatebutEqual:MedicalEducationforWomen."In
SympathyandScience:WomenPhysiciansinAmericanMedicine,73.NewYorkCity,NY:Oxford
UniversityPress,1985,73.Examplesofcandidateswhoweretooradicalbelievedinhydropathyand
otherhomeopathictreatmentsandworebloomers.
16
Longshore,Joseph."TheFirstFemaleMedicalCollege:"WillYouAcceptorRejectThem?""TheFirst
FemaleMedicalCollege:"WillYouAcceptorRejectThem?"October4,1850.AccessedDecember12,
2014.http://doctordoctress.org/islandora/object/islandora:1496.
17Luchetti,Cathy.MedicineWomen:TheStoryofEarly-AmericanWomenDoctors.NewYork:Crown
Publishers,1998.14-15.
14
women.18ElizabethBlackwellobtainedherMDbystudyingatamalemedical
school.Butthisoptiondidnotexistformostaspiringwomendoctors.Forexample,
followingBlackwell’sgraduationatthetopofherclass,GenevaMedicalCollege
refusedadmissiontosubsequentfemaleapplicants.EmilyBlackwellbeganstudying
atRushMedicalCollegeinChicagobeforeshewasaskedtoleave,ultimately
completingherdegreeinCleveland.19
Meningeneral,andmalephysiciansespecially,consideredfemalephysicians
de-sexed.Thiswasespeciallydestructivetowomendoctorsbecausethey
consideredtheirfemininityacriticalpartofwhattheyhadtooffer.Early
justificationsfrompeoplesuchasElizabethBlackwellincludedthedesiretoinstilla
maternal,distinctlywomanlyaspecttomedicineinthelightofitshard-hearted
reputation.20Beforetheadventandspreadofanesthesia,physiciansfrequentlyhad
toconsiderhowmuchpaintoinflictonpatients,constructingtheirreputationsas
coldandcalculating,andbereftoftheempathyandcompassionearlywomen
physicianshopedtoaddtotheprofession.21VirginiaPenny,inherCyclopaediaof
Women’sEmployment,arguedthatthe“mildnessandamiabilityofwoman,her
modesty,herdelicacyandrefinement,alltendtomakeheracceptableatthe
18Morantz-Sanchez,ReginaMarkell.SympathyandScience:WomenPhysiciansinAmericanMedicine.
NewYork:OxfordUniversityPress,1985.66,75.
19"ChangingtheFaceofMedicine|Dr.EmilyBlackwell."U.SNationalLibraryofMedicine.Accessed
December15,2015.
https://www.nlm.nih.gov/changingthefaceofmedicine/physicians/biography_36.html.
20Morantz-Sanchez,ReginaMarkell.SympathyandScience:WomenPhysiciansinAmericanMedicine.
NewYork:OxfordUniversityPress,1985.191.
21Pernick,MartinS.,andRonaldL.Numbers."TheCalculusofSufferingin19th-CenturySurgery."In
SicknessandHealthinAmerica,editedbyJudithWalzerLevitt,98.Madison:UniversityofWisconsin
Press,1985.
15
bedside.”22WhilePennywaspromotingwomen’semployment,andassuchwas
necessarilybiased,thisargumentwasalsosupportedbyothers,includingElizabeth
BlackwellandJosephLongshore,oneofthefoundersoftheWomen’sMedical
CollegeofPhiladelphia.
Manyoftheseearlypioneers—theBlackwellsistersandMarieZakrzewska,
amongstothers—becamefoundersofandteachersatwomen’smedicalcolleges.
Whilewomen’smedicalcollegesofferedexcellentmedicaleducation,theywere
marredbyacontinual,insidiousfearofinferiorityincomparisontomalemedical
institutions.23TheyadheredstrictlytothemostrecentregulationsoftheAmerican
MedicalAssociationandoftenquicklyandefficientlyquashedanysuspicionsthat
homeopathywasapartoftheircurriculum.Despitethechallengesconfronting
femalemedicalcolleges,theyofferedtotheirstudentssomethingmale-dominated
andlatercoeducationalmedicalcollegesdidnot—astrongnetworkoffemale
professionalandpersonalsupport.24
Inordertoelucidatetheimportanceofearlyfemalemedicaleducation,itwill
beessentialtounderstandthegeneralstatusofmedicineatthistime,inorderto
providecontextregardingtheprofession.Next,acomparisonofseveralwomen’s
medicalcollegeswillproveuseful,withanemphasisontheWomen’sMedical
22Penny,Virginia."Physicians."InTheEmploymentsofWomen:ACyclopaediaofWoman'sWork,15.
Boston,MA:Walker,Wise,andCompany,1863.
23Morantz-Sanchez,ReginaMarkell.SympathyandScience:WomenPhysiciansinAmericanMedicine.
NewYork:OxfordUniversityPress,1985.65.
24Tuchman,Arleen.ScienceHasNoSex:TheLifeofMarieZakrzewska,M.D.ChapelHill:Universityof
NorthCarolinaPress,2006.81.
Forexample,ElizabethBlackwellhelpedinitiateMarieZakrzewska’sentranceintomedicalschool,
includingsendinghertextbooksandfundraisingforhertuition.Later,Zakrzewskamovedinto
Blackwell’shome,andunabletofindalandlordwillingtolettoawomanphysician,openedapractice
inherparlor.
16
CollegeofPhiladelphia,theMedicalCollegeattheNewYorkInfirmaryforWomen
andChildren,andtheNewEnglandFemaleMedicalCollege.Wemustthenexamine
howtheseinstitutionswerereceivedandhowtheykeptupwithAmericanMedical
Associationguidelinesandsocialconventionsformedicaleducation,aswellashow
studentsfromtheseinstitutionswerereceivedbymaledoctorsandmedical
students.Iwillalsoaddressthedeclineofexclusivelyfemalemedicaleducation,and
theeffectsofcoeducationonwomenphysicians.
In1848,therewerenonationalstandardsofeducationrequiredformedical
licensing.Still,thereweremanymedicalschools.Theseearlymedicalschools
operatedfunctionallyasbusinesses,tryingtoeaseaccessforconsumers,inthiscase
tuition-payingstudents.Theseproprietarymedicalschoolsheldstatechartersand
workedforprofit.Thismeantthatrequirementswerelow,sothatasmanystudents
aspossiblecouldqualify,withmanyonlyrequiringahighschooldiplomafor
acceptance.Lestthatbetoostringent,however,especiallyinatimepriortothe
adventofpublicsecondaryeducation,theyalsoacceptedanambiguous
“equivalent.”25Onceaccepted,studentsattendedaseriesoflecturesoverthecourse
ofafewmonths.Then,ayearlater,thesamelectureswouldbeheardasecondtime,
andperhapsadissertationwritten,andthestudentwouldgooffforfurtherhandsontraining.26Thistrainingtooktheformofanapprenticeshipwithanestablished
doctor,maintainingsuchtraditionalaspectsofapprenticeshipaspayingforthe
25Hudson,RobertP.,andRonaldL.Numbers."AbrahamFlexnerinPerspective."InHealthand
SicknessinAmerica,editedbyJudithWalzerLevitt,148.2nded.Madison:UniversityofWisconsin
Press,1985.
26Ibid.
17
opportunitytolearn,andperforming“repetitive,laborious,day-to-daywork.”27
Importantly,fewwomenphysicianswereabletogainapprenticeshipsintheUnited
States,eitherbecausetheycouldnotaffordtopaytheiremployers,ortheywere
barred,aswomen,fromsuchemploymentopportunities.Thosewhowereableto
acquirefurthertrainingdidsoatwomenandchildren’shospitalsoftenrunand
foundedbywomen.ElizabethBlackwell’sNewYorkInfirmaryforWomenand
Childrenwasoneexampleofsuchaninstitution.Itprovidedpost-graduatetraining
forMarieZakrzewska,MaryPutnamJacobi,andRebeccaCole,anearlyblackwoman
physician,amongothers.28
ElizabethBlackwellfoughtherwayintothissystemofmedicaleducation.
Uponenteringherclass,shewasmarkedlymorepreparedthanheraverage
classmate,havingtrainedwithananatomistandstudiedunderaDr.Allenin
Philadelphiapriortomedicalschool.29Aftercompletingthecurriculum(takingthe
samelecturesfortwoyears),andgraduatingattheheadofherclass,Blackwellfelt
thathereducationwasstillinsufficientforhertoenterpractice.Giventhedifficulty
womenfacedinbeingawardedapprenticeships,BlackwellwasadvisedthatEurope
wasmoreopentowomenphysicians.PriortoheradmissiontoGenevaMedical
College,shehadbeenadvisedtodressasamaninordertoobtainamedical
27Luchetti,Cathy.MedicineWomen:TheStoryofEarly-AmericanWomenDoctors.NewYork:Crown
Publishers,1998.18.
28"ChangingtheFaceofMedicine|Dr.MaryCorinnaPutnamJacobi."U.SNationalLibraryof
Medicine.AccessedApril22,2016.
https://www.nlm.nih.gov/changingthefaceofmedicine/physicians/biography_163.html.
ChangingtheFacepages
29Blackwell,Elizabeth.PioneerWorkinOpeningtheMedicalProfessiontoWomen;Autobiographical
Sketches.NewYork:Longmans,Green,and,1895,58-59.
18
education30WhilethismayhaveresultedinBlackwellacquiringthemedical
knowledgeshesought,shewouldhavedonesowithoutbringingtothefieldthe
distinctlyfemininetraitssheprized,thematernalinstinct,care,andcompassionshe
feltincumbentuponwomentobringtomedicine.Thisstrategydidprovesuccessful
forDr.Barry,abiologicallyfemalephysicianwhospentheradultlifedisguisedasa
man(goingbythenameJamesratherthanherbirthnameMiranda).Sheeventually
becameinspector-generalofhospitalsintheBritisharmy,andhertruesexwas
foundoutonlyafterherdeath.31Blackwell,however,refusedtodisguiseherself,as
thiswasinimicaltoherreasonsforbecomingaphysician.Shewishedtoprovethat
womencouldbegoodphysicianswhilemaintainingtraditionallyfemininequalities.
Shealsowishedtoremedythepoorreputationof“femalephysicians,”astheterm
wasoftenusedatthetimeasaeuphemismforanabortionist.32Whileshedecided
togotoEuropeandstudiedinFranceandBritain,sherefusedtodisguiseher
femininity.Sheobtainedextensiveclinicalexperience,particularlyinobstetrics.33
Thisbeganapatternthatwasfollowedbyheryoungersisterandanumberofother
femalephysicians,especiallythosewishingtospecializeinaparticularkindof
medicine.
BarryandBlackwellprovideaninterestingcontrastinthewaysinwhich
womenapproachedmedicine.WhileBarryclearlyenteredmedicinedespiteher
femininity,andrenouncedherfemininepresentationforherentireadultlifein
30Ibid.
31Luchetti,Cathy.MedicineWomen:TheStoryofEarly-AmericanWomenDoctors.NewYork:Crown
Publishers,1998.19.
32Blackwell,Elizabeth.PioneerWorkinOpeningtheMedicalProfessiontoWomen;Autobiographical
Sketches.NewYork:Longmans,Green,and,1895.30.
33Ibid,123.
19
ordertodoso,Blackwellrefusedtorelinquishherfemininity,asshefeltthatthis
waswhatuniquelyqualifiedheranddestinedhertoentermedicine.Tounderstand
herperspective,itisusefultorevisitBlackwell’sautobiographyandexamineher
interestinmedicine—itwasnotaninterestinthescientificpursuitofmedicinethat
motivatedhertobecomeaphysician.UnlikethescientificadvancesmadebyMary
PutnamJacobiandAliceHamilton,Blackwelldevotedherlifealmostexclusivelyto
thecareoffemalepatients,bothadultsandchildren.Shewroteabouthowmothers
shouldeducatetheiradolescentdaughtersaboutsex,howgirls’educationingeneral
shouldbealtered,andhowgirlsshouldberaised.Infact,Blackwelladmittedtoan
initialrevulsiontothehumanbodyandthestudyofanatomyinherPioneerWork.34
Still,Blackwellwasdrawntomedicine,despitehermisgivings,afteraterminallyill
familyfriendinformedherthatherworstsufferingswouldhavebeenalleviatedby
havingafemalephysician.35
WedonothavecomparableinformationonBarry.Thismakessense,of
course,giventhatshelivedherentireadultlifeasaman,withthediscrepancy
betweenherbiologicalsexandherpresentationbeingmadepubliconlyafterher
death.Barryservedinthemilitaryasasurgeon.DescriptionsofDr.JamesBarry
describedhimasabrasiveandaggressive.Barrywasknowntohaveparticipatedin
aduel“andsoughtmanymore,”demonstratinganaggressionthatwouldhavelikely
beenseenasclassicallymasculine.36Thesequalitiesseemedincongruouswiththe
34Blackwell,Elizabeth.PioneerWorkinOpeningtheMedicalProfessiontoWomen;Autobiographical
Sketches.NewYork:SourceBookPress,1895,27.
35Ibid.
36Loudon,I."Book:ScantyParticulars:TheStrangeLifeandAstonishingSecretofVictorian
AdventurerandPioneerSurgeonJamesBarry."BMJ324,no.7349(2002):1341.
doi:10.1136/bmj.324.7349.1341.
20
presumedvirtuesoffemininityextolledbyBlackwellandotherearlysupportersof
femalephysicians.Nonetheless,whileBarryeschewedaclassicallyfemale
presentation,shedidparticipateinreformworkandaidofunderserved
populations,inmuchthesamewaythatBlackwellwouldinNewYork.While
Blackwell’sNewYorkInfirmaryforWomenandChildrenservedpoorwomenand
childreninNewYorkCity,Barryledprisonreformsandofferedmedicaltreatment
tolepersinCapeTown,SouthAfrica.37
Ofcourse,Blackwellwasnottheonlyopenlyfemininewomanreceivinga
medicaleducationatthistimeandin1850theWomen’sMedicalCollegeof
Philadelphia(originallynamedtheFemaleMedicalCollegeofPhiladelphia)was
founded.38Theinitialfacultyofthisinstitutionleanedratherheavilytowards
homeopathictreatments,whichcontributedtowardstheschool’spoorreception
amongstothermedicalprofessionalsinPhiladelphia.C.N.PrincewrotetoClara
Marshallthat“sointensewasthefeelingonthepartoftheprofessionagainstthe
menwhowerewillingtoacceptprofessorshipsintheschoolorgiveinstructionto
women,thatitwaswithdifficultythatgoodteacherscouldbeobtained.”39This
suggeststhatonlythosewhowerealreadymarginalizedintheprofessiontosome
extent,likelyduetotheirhomeopathicviews,wouldhavechosentoteachatthe
college.
37Loudon,I."Book:ScantyParticulars:TheStrangeLifeandAstonishingSecretofVictorian
AdventurerandPioneerSurgeonJamesBarry."BMJ324,no.7349(2002):1341.
doi:10.1136/bmj.324.7349.1341.
38Morantz-Sanchez,ReginaMarkell.SympathyandScience:WomenPhysiciansinAmericanMedicine.
NewYork:OxfordUniversityPress,1985.76.
39Marshall,Clara.TheWoman'sMedicalCollegeofPennsylvania:AnHistoricalOutline.Philadelphia,
Pennsylvania:P.Blakiston,1897.12.
21
Homeopathywasmoreopentowomenthan‘regular’orallopathicmedicine
was,partiallyduetoalternativepathwaysoftraining—apprenticeshipsratherthan
formalmedicalschoolcouldbesufficientforahomeopathtosetupapractice.
Additionally,sectarianmedicalschoolsweremorefrequentlycoeducationalthan
theirregularallopathiccounterparts.Forexample,Chicago’sBennettCollegeof
EclecticMedicineandHahnemannMedicalCollegewerebothopentowomen
studentsbeforetheregularChicagoMedicalCollege.40Itwasalsomorereceptiveto
agroupmarginalizedfortheirsexbecausewithintheprofession,homeopathswere
alsoostracized,theirbeliefsconsidered‘quackery’bymanyregularphysicians.It
wasnotuncommontoseehusbandandwifeinpracticetogether,starting
hydropathyclinicsorpracticingotherformsofhomeopathicmedicine.Some
womenhadobtainedapprenticeshipswithouthavingbeentoaformalmedical
school.
Untilrecently,therewascomparativelylittleinterestinthestudyofsectarian
orhomeopathicfemalephysicians.Inlightofrecentresearch,however,some
historiansarguethat“sectarianmedicalschoolshelpedprovidewomenwithaccess
tomedicaleducationbeforewomen’smedicalschoolsexisted,”despiteacontinued
beliefthatwomen’smedicalcollegeswerethemajoravenueforwomen’smedical
education.41Itisalsointerestingtonotethatwhilemostregularfemalephysicians
graduatedfromanall-femalemedicalschool,mostoftheirfemalesectarian
counterpartsgraduatedfromcoeducationalinstitutions,suchasPennMedical
40Fine,Eve.“WomenPhysiciansandMedicalSectsinNineteenth-CenturyChicago.”InWomen
PhysiciansandtheCulturesofMedicine,249.Baltimore,MD:JohnsHopkinsUniversityPress,2009.
41Ibid,246.
22
UniversityandClevelandMedicalCollege.42EveFineusesChicagoasafocalpoint
forthecomparisonofsectarianandregularwomenphysicians.Inthecityof
Chicago,therewerenorequirementstoenterintomedicalpracticeuntil1878,
makingthefieldthereopentoalternativemedicalbeliefsandpractices.Thefirst
women’smedicalcollegeinChicagoopenedin1871.Beforethis,mostofthecity’s
womendoctorsweresectarians.43
Itseemsclear,then,thatwomenseizedtheopportunityofferedbythis
slightlymorepermissivesubsetofmedicalpractitioners.Itwasagroupofmenwith
homeopathicleaningswhowentontofoundandteachattheWomen’sMedical
CollegeofPhiladelphia.However,oncethecollegewassufficientlyestablished,the
schoolgraduallyturnedawayfromhomeopathictrainingoverthecourseoften
yearsinfavorof‘regularizing’thecollege,afterwhichnoneoftheoriginalfaculty
remainedatthecollege.Thiswasamoveaimedatimprovingthereputationofthe
schoolandadheringtoitspolicyofregular,minimally-controversialmedical
education.Thechangewasnotasextremeasitsounded—someofthenew
professorswererecentgraduatesofthecollege,taughtbythesamehomeopathysympathizingprofessorstheyreplaced.SusanWellsdescribestheWMCP’searly
effortstomaintainregularmedicineinthefaceofhomeopathyas“aconstant
struggle,seldomexplicit,tolimitprofessorshipstoregularratherthanEclectic
doctors.”44Inpart,thisshiftwastheconsequenceoftheriseofallopathicmedicine
42Morantz-Sanchez,ReginaMarkell.SympathyandScience:WomenPhysiciansinAmericanMedicine.
NewYork:OxfordUniversityPress,1985.76,93.
43Ibid,246.
44Wells,Susan.OutoftheDeadHouse:Nineteenth-CenturyWomenPhysiciansandtheWritingof
Medicine.Madison:UniversityofWisconsinPress,2001.127.
23
anddeclineofsectarianpractitioners.Homeopathy,thoughamoreopenpathway
forwomentopracticemedicine,wasincreasinglymarginalizedbytheallopathic,or
regular,medicalcommunity.Womenphysicians,alreadyostracizedbyalarge
portionoftheprofession,soughttoaddressthepossibilityoffurther
marginalizationbyadheringtocurrenttrendsinmedicaleducation..Women’s
medicalcollegeswerealreadynecessarilycontroversialintermsofthestudents
theytaught–theirgoalwastobeminimallycontroversialinotheraspects,including
thetechniquesandideologiestheysubscribedto.
JosephLongshoreisoneofthebestexamplesofthis.Anotablehomeopath,
hewasoneofthefoundersoftheWMCP.45Hissister-in-lawHannahLongshorewas
oneofthecollege’searliestgraduates,andfoundherselfsomewhatdividedfromher
fellowalumnaefollowinggraduationduetohercontinuedhomeopathic
sympathies.46Withinafewyearsoftheschool’sfounding,Longshorefoundhimself
ousted.HewentontofoundthePennsylvaniaMedicalUniversity,acoeducational
sectarianmedicalschool,afterleavingtheWMCP.47
Butwhydidthishappen?Thesephysicians,homeopathicornot,clearly
demonstratedabeliefinandsupportforwomen’smedicaleducationatatimeand
placewheresuchsupportwasrare.Itseemscounterintuitivetoremovemanyof
thesemenwhentheyhadbeeninstrumentalinopeningthecollegeinthefirstplace,
atgreatpersonalandprofessionalcost–losingtherecognitionoftheprofessionat
large,particularlythatofregularphysicians.Inordertoanswerthisquestion,we
45Wells,Susan.OutoftheDeadHouse:Nineteenth-centuryWomenPhysiciansandtheWritingof
Medicine.Madison:UniversityofWisconsinPress,2001,122.
46Ibid.
47Ibid,128.
24
mustexamineattitudestowardswomen’smedicaleducation,focusingonthe
attitudesofwomengoingthroughtheseprogramsthemselvesandtheopinionsof
theirmalecolleagues.
Antebellummedicaleducationconsistedmainlyofproprietarymedical
schoolsoperatingwithlittleinterventionorsupervisionfromthestate.Licensing
requirementsvariedfromstatetostate,butmosthadhadnoformallicensing
requirementsthatschoolshadtoadhereto.Soschoolscould,inadditiontohaving
fewrequirements,makemedicaleducationfairlyquickandeasy—thesamesetof
fifteenorsolecturesgiventwoyearsinarowforafewmonthsoftheyear,an
optionalthesis,andgraduationwaspracticallyguaranteed.48In1834,Elizabeth
Blackwell’salmamaterGenevaMedicalCollegehadprofessorsofchemistry,
anatomyandphysiology,“theInstitutesandPracticeofMedicine,”the“Principles
andPracticeofSurgery,”obstetricsandmateriamedica,andmedicaljurisprudence
andbotany.49DuringherfirstyearofstudyattheUniversityofMichiganCollegeof
Medicinein1890,AliceHamiltonstudied“obstetricsandgynecology,thetheoryand
practiceofmedicine,surgery,materiamedica(pharmacology)descriptiveand
surgicalanatomy,physiology,embryology,chemistry,toxicology,andurinalysis.”50
Shiftsineducationwereevident,asmuchofHamilton’sinstructionwasinthe
48Morantz-Sanchez,ReginaMarkell.SympathyandScience:WomenPhysiciansinAmericanMedicine.
NewYork:OxfordUniversityPress,1985,68-69;Hudson,RobertP."AbrahamFlexnerinPerspective:
AmericanMedicalEducation,1865-1910."InSicknessandHealthinAmerica,editedbyJudithWalzer
LeavittandRonaldL.Numbers,148.Seconded.London:UniversityofWisconsinPress,1985.
49CircularandCatalogueoftheFacultyandOfficersoftheMedicalInstitutionofGenevaCollege,
Geneva,NewYork,September1834.Oliphant&Skinner,Auburn.(accessedatSUNYUpstateMedical
UniversityArchives,August4,2015).
50Sicherman,Barbara,andAliceHamilton.AliceHamilton,aLifeinLetters.Cambridge,Mass.:
HarvardUniversityPress,1984.36.
25
laboratorywherelittleofBlackwell’shadbeen,forty-twoyearsearlier.51Wealso
seecurriculardifferences–Hamiltonstudiedchemistry,toxicology,andurinalysis,
noneofwhichweretaughtwhenBlackwellhadbeeninschool.
Thelaxnatureofmedicaleducationatthistimemeantthatalltypesof
studentscouldenter,andcouldeitherstudywithpassionanddevotion,orgoto
classduringthedayandthebeer-saloonatnight,andgraduatewithequivalent
credentials.Societybeganlosingrespectforthemedicalprofessionasawholeupon
seeingthisbehavior.CitizensofGeneva,NewYork,forexample,oftencomplainedof
thedisturbancecausedbythemedicalstudentsthere.OneofthemostremarkeduponaspectsofElizabethBlackwell’stimetherewashersuccessinunintentionally
influencingthebehaviorofherrowdyclassmates,butsimplybyherpresence.
Womenoftenarguedthattheircivilizinginfluencewasamajorreasontheyshould
benotonlyallowed,butencouragedtostudymedicine.
Additionally,newscomingoutofFranceandGermanyprovidedscientific
evidencethatcommonlyusedmedicaltreatmentswereineffective.52Priortothis
revelation,doctorsweregenerallytrustedtohealpatients,andwereseenashaving
theauthoritytodoso.53However,afterthepubliclearnedthatthemethodsthey
hadbeentreatedwithforsolongwerenotinfacthelpingthem,doctorslostthat
51Ibid;CircularandCatalogueoftheFacultyandOfficersoftheMedicalInstitutionofGenevaCollege,
Geneva,NewYork,September1834.Oliphant&Skinner,Auburn.(accessedatSUNYUpstateMedical
UniversityArchives,August4,2015
52Hudson,RobertP."AbrahamFlexnerinPerspective:AmericanMedicalEducation,1865-1910."In
SicknessandHealthinAmerica,editedbyJudithWalzerLeavittandRonaldL.Numbers,148.Second
ed.London:UniversityofWisconsinPress,1985.
53Rosenberg,CharlesE.,andRonaldL.Numbers."TheTherapeuticRevolution:Medicine,Meaning
andSocialChangein19th-CenturyAmerica."InSicknessandHealthinAmerica,editedbyJudith
WalzerLeavitt,39-50.Madison:UniversityofWisconsinPress,1985.
26
authority.Bythe1830s,therewasnolongercommonlyacceptedproofbackinga
singlemedicalideology,andsomanynewbranchesofmedicinewithdivergent
philosophiesarose.Someoftheseincludedmesmerism,magnetism,Thompsonian
medicine,hydropathy,andhomeopathy.54Thesedeparturesfromtraditional,or
allopathic,medicine,werecalledsects,andfellundertheumbrellaofsectarian
medicine.Theopeningofthefieldallowedideologicalpluralismtogrowin
medicine.ThisresultedinhomeopathicphysicianssuchasLongshoreandhis
colleaguesopeningmedicalcolleges.Asthesenontraditionalgroupsgrewin
numbersandpopularity,theyposedagreaterthreattotraditional,orallopathic,
physicians.Traditionalpractitionersdislikedthesenewdisciplinesfirstbecause
theydifferedfromwhattheyconsideredtruemedicinetobe,andsecondbecauseof
theeconomiccompetitionthattheycreated.Dislikeanddistrustofhomeopaths
continuedaswomengainedentryintomedicine,somethingthefoundersand
graduatesoftheWMCPexperiencedfirsthand.Likewise,oneofthereasons
supportersurgedElizabethBlackwelltoopenamedicalschoolattachedtoherNew
YorkInfirmaryforWomenandChildrenwasinordertopreventfemalestudents
fromgoingtoNewYorkMedicalCollegeforWomen,asectarianinstitution.
Furthermore,asapplicantsarrivedforherschool,Blackwell(aswellashersister
andGerman-bornMarieZakrzewska)washighlyselectiveinthestudentswhowere
selected.Zakrzewskareferredtosomeapplicantsas“extremists,”anddiscussed
hydropathswhowereturnedawaybecause“popularprejudicescouldbeovercome
54Ibid.
27
onlyinthemostcarefulandconservativemanner.”55Thismeantthatwomenwho
favoredhydropathywererefused,aswerewomenwearing“veryshortBloomer
costume,withhaircutveryshort.”56Sowomenwhowerenoticeablyradical,either
indressorinmedicalbeliefswereturnedawayfromclinicalpractice.
Duringthesecondhalfofthenineteenthcentury,whenthegeneral
practitionerwasstillhighlyrespected,beforespecialistsrosetohighersocialstatus
withintheprofessionandwithinsocietyingeneral.Generalpractitioners,asdefined
byhistorianIrvineLoudon,heldqualificationsinbothsurgeryandmedicine.Atthis
time,moresurgicalprocedureswerebeingreplacedbymedicaltreatments,soit
wasadvantageoustobefamiliarwithboth,totheextentthatthosewhospecialized
inaparticularorganwereseenas“menwhohadfailedinthegeneralfieldsof
physicorsurgeryandwereforcedtosetupasspecialistsinordertoattract
business.”57Loudonaddsanadditionaldimensionofcompetitiontomedical
practitioners:notonlywere‘regular’physicianscompetingwithvariousbranchesof
osteopaths,butgeneralpractitionerswerealsocompetingagainstsurgeonsand
physicians.Loudondescribes“anagethatadmiredbreadthofknowledgerather
thannarrowspecialization,”whichcanhelpexplainwhywomenphysicianssuchas
ElizabethandEmilyBlackwell,andnumerouscontemporaries,soughttrainingin
variousfieldsofmedicineratherthanchoosingtohoneinonaspecificarea.58
55Morantz-Sanchez,ReginaMarkell."SeparatebutEqual:MedicalEducationforWomen."In
SympathyandScience:WomenPhysiciansinAmericanMedicine,73.NewYorkCity,NY:Oxford
UniversityPress,1985,73.
56Ibid.Morantz-SanchezquotesZakrzewskahere.
57Loudon,Irvine.MedicalCareandtheGeneralPractitioner,1750-1850.Oxford:ClarendonPress,
1986.189-191.
58Ibid.
28
Womenmedicalstudents,infact,oftenpursuedamorerigorouscourseof
studybeforeenteringmedicalschool.Thisservedtoprovethatwomeningeneral
couldaccruescientificknowledge,andweretoughenoughtostudysubjectmatter
thatwasconsideredgrotesque,whichhelpeddefeattheprimaryargumentsagainst
womenstudyingmedicine–thatwomenwereincapableofrationalthinkingand
weretoodelicatetostudythehumanbody.ElizabethBlackwellhadstudiedunder
severalphysiciansandananatomist,andhaddonedissectionsbeforeevenstepping
footinamedicalclassroom.AliceHamilton,whoenteredtheFortWayneCollegeof
Medicine,didsoin1890(overfortyyearsafterBlackwell),havingpreviously
studiedchemistryandphysicswithahighschoolteacherandhaving“worked
biologyinFortWayneandMackinac.”59Heracademicexcellencewasrecognizedby
herprofessors,andwasrewardedbysupplementaryworkandtheopportunitiesto
assistinoperationsandprescribemedicineforcharitypatients(thelatterwas
sometimesaccompaniedbyafee.)MaryPutnamJacobialreadyhadadegreefrom
theNewYorkCollegeofPharmacybeforeenteringtheWMCPtoattainherfirst
medicaldegree,andthenlatertravelingtoFrancetofurtherhertraining.60
Asimilarsortofmentalitycanexplaintheturnoverseenafewyearsafterthe
foundingoftheWomen’sMedicalCollegeofPhiladelphia,aswellastheconstant
desireforcoeducationandthecontinualfear,propagatedbymalephysicians,that
female-onlymedicalschoolswouldbelessthoroughthanmale-dominatedones.The
59SichermanandHamilton,34-35.
60"ChangingtheFaceofMedicine|Dr.MaryCorinnaPutnamJacobi."U.SNationalLibraryof
Medicine.AccessedDecember15,2015.
https://www.nlm.nih.gov/changingthefaceofmedicine/physicians/biography_163.html.
29
Blackwells’medicalcollege,openedin1868,hadamorerigorouscurriculumthan
mostotherschools,requiringthreeyears,obligatoryhospitaltrainingalongside
lecture-basededucation,andatotaloftenprofessors(threeofwhomwerefemale).
Occasionally,theAMAmaderecommendationsondifferentaspectsof
medicaleducation—thesizeofmedicalschools,thelengthofterms,andtherigorof
examinations,forexample.Becausetherewaslittlegovernmentoversight,andthe
AMAitselfhadlittlepowertoenforcetheserecommendations,mostschoolswere
slowtoadheretothem.In1867,justbeforetheBlackwellsistersopenedtheir
school,theAMAreleasedanewreportrecommendingagradedcurriculum,yearly
examinations,andafacultyofatleastnineprofessors.In1874,theAMA
recommendedthatmedicalcollegeshavetermsofsixandahalfmonthsforthree
yearsofstudy,withmorerigorousacademicbackground,dissection,andclinical
experience,atschoolswithatleastsevenprofessors.61Women’smedicalcolleges
weresomeofthefirsttoadjusttonewAMArecommendations.Thisrapid
adaptationtochangingdefinitionsofadequateandrigorousmedicaleducationwas
reflectiveofthedesireofwomen’smedicalschoolstoavoidloweringtheir
standards.
Inadditiontothesepressures,therewasalsoasensethatwomen’smedical
schoolssimplydidn’tpreparetheirstudentsformedicalpractice.Whilegraduation
fromtheWMCPoranotherwomen’smedicalcollege(therewasanotherinNew
England)gavewomenthelegalrighttopracticemedicine,therewasageneral
61Morantz-Sanchez,ReginaMarkell."SeparatebutEqual:MedicalEducationforWomen."In
SympathyandScience:WomenPhysiciansinAmericanMedicine,73.NewYorkCity,NY:Oxford
UniversityPress,1985,74-75.
30
opinionthatthiswasn’tquitegoodenough–Blackwellwasoneofmanywomen
whoadvocatedapracticaleducationinEurope,declaringitwas“almostimpossible
foraladytogetagoodmedicaleducationwithoutgoingtoEurope,”62where
studentscouldbuildfirsthandknowledgethroughextensivecaseobservationsand
wardrotations.MaryPutnamJacobi,EmmelineCleveland,andEmilyBlackwell
(Elizabeth’syoungersister)werenotableexamplesofotherwomenwhopursueda
practicalEuropeaneducationfollowingtheirgraduation.Thispersisteduntil
Blackwellopenedherownhospital,whichthensawmanynewgraduatestrain
domestically.Whenshewasunsatisfiedwiththeireducationalbackgrounds,she
proceededtoaddamedicalcollegetothehospital.Evenwhentheeducationitself
was‘goodenough,’i.e.comparabletothatreceivedfromamalemedicalcollege,
thereremainedacontinuinginsidiousfearofwomengraduates.Thisdirectly
shapedstricteducationalstandardsupheldinwomen’smedicalcolleges.Historian
ReginaMarkellMorantz-Sanchezarguesthat“mostwomenphysiciansclungtoa
beliefinthenecessityofcoeducationlargelybecausetheydoubtedwomen’sability
tocreateseparateinstitutionscommensuratewithmalestandards.”63Until
coeducationwasmadeavailable,womendoctorsfacedtherealitythattheonusto
providewomenwithmedicaleducationrestedonthemandonanymalecolleagues
sufficientlysympathetictothecause,andeventhentheseinstitutionswereoften
perceivedasinsufficientinstitutionsofmedicaltraining—regardlessofthehigh
standardsoftheircurriculum.
62Penny,Virginia."Physicians."InTheEmploymentsofWomen:ACyclopaediaofWoman'sWork,25.
Boston,MA:Walker,Wise,andCompany,1863.
63Morantz-Sanchez,ReginaMarkell.SympathyandScience:WomenPhysiciansinAmericanMedicine.
NewYork:OxfordUniversityPress,1985,85.
31
Whateverreputefemalemedicalcollegesdidgarner—goodandbad—often
hingedonthereputationsoftheirfounders.TheNewEnglandFemaleMedical
CollegeinBostonwasfoundedbySamuelGregory,ahealthreformerwhohadno
formalmedicaleducation.Gregorywasoutragedbythefadofmalemidwivesand
sawthemasoffensivetofemininemodestyanddelicacy,andsobeganaschoolfor
femalemidwives.Thisschool,foundedin1848,gotanewcharterin1856asa
femalemedicalcollege.Anumberofinfluentialwomen’srightsactivistsaidedinits
funding.Soon,MarieZakrzewska,oneofElizabethBlackwell’shandpicked
protégéesandfriends,wasteachingthere.Despiteapromisingstart,theschool
soonfaltered.Zakrzewskaleftshortlyafterjoiningthefaculty,findingthat
Gregory’smedicalconservatism,resistancetonewtechnologyanddomineering
personalitywereruiningthereputationoftheschoolandfearingthedestruction
coulddestroynotonlyofherowncareer,butalsooftheentiremovementofwomen
inmedicine.64Morantz-Sanchezarguesthatthepoliticizationoftheschoolwithout
scientificorprofessionalbackingwasoneofthemainreasonsthatitwasnot
academicallyrigorous,anddidnotearnthereluctantacceptancethattheWMCPand
Women’sMedicalCollegeoftheInfirmaryofNewYorkeventuallywereableto.65
WhenactivistslikeGregorywithnomedicalexperiencestartedinterferingwith
medicaleducationforwomen,theyoftenriskedtheventureasawholeandwere
censurednotonlybyopponentsofwomeninmedicine,butalsobymaleandfemale
64Morantz-Sanchez,ReginaMarkell.SympathyandScience:WomenPhysiciansinAmericanMedicine.
NewYork:OxfordUniversityPress,1985,80-82.
65Ibid,81.
32
doctorsalike,includingZakrzewskaandMaryPutnamJacobi,twoofBlackwell’s
formerstudents.
DespitethenegativeattentionattractedbyGregory’sinstitution,hisoutrage
atmalemidwiferyorbeliefinfemininedelicacyweresharedbymanyproponentsof
femalephysicians.Theseideaswereinfactcentraltotheargumentwomendoctors
weremakingindefenseoftheirroleintheprofession.Societalproprietydictated
thatwomenpracticemodestyanddelicacy,andencourageddiscretionin
discussionsofissuesdefinedasgenderedandthusofasensitivenature:pregnancy,
childbirth,breastcancer,andreproductivedisorders,tonamebutafew.Eveneye
problemsandothersymptomsthatarenolongerassociatedwiththepatient’ssex
werecharacterizedasgendereddisordersatthistime.Oneofthemostfamous
examplesofthiswasBlackwell’sfamilyfriend.Itiscriticaltonotethatthiswasinno
wayanisolatedcase.Womenwithhealthproblemsfrequentlydieddueto
reluctancetodisclosesymptomstoaman.Itwasalsocommonlybelievedthatmen
misdiagnosedwomen,beingunabletofullyunderstandwomen’sdiseasesinthe
wayawomanwouldbeableto.66
WhenonecomparestheNewEnglandFemaleMedicalCollegetothe
Women’sMedicalCollegeofPhiladelphia,foundedbyagroupofQuakermen
notablyincludingJosephLongshore,wecancomparethedifferentwaysinwhich
theinstitutionsreactedtocriticismofthequalityandcontentoftheireducation.
WhenLongshoreandhiscolleagues’homeopathicbeliefsbegandamagingthe
credibilityoftheinstitutionanditsgraduates,theyweregraduallyremovedand
66Morantz-Sanchez,ReginaMarkell.SympathyandScience:WomenPhysiciansinAmericanMedicine.
NewYork:OxfordUniversityPress,1985,210.
33
replacedwithfemalegraduates.67Inthisway,theWMCPsaveditselffromthetype
ofinfamyearnedbyitsBostoniancounterpart.ElizabethBlackwell’sWomen’s
MedicalCollegeoftheInfirmaryofNewYorkneverriskedlosingitscredibilityasan
institutionofmedicaleducation,asBlackwell’srigidlyregularopinionsand
incrediblysevereexaminationswererenowned.Blackwellalsohadpowerful
connections,bothinAmericaandinEngland,whowerewidelyrespectedand
wealthyenoughtoensurethatherschoolneversufferedunderthedireeconomic
straitsofitscousinsinPhiladelphiaandothercities.Thisallowedhertoprotecther
owninstitutionfromtheharshscrutinyfacedbyotherwomen’smedicalcolleges
liketheWMCP,despitetheiracademicrigor.68
ItisimportanttoreflectonthedifferencesbetweentheWMCPandtheNew
YorkInfirmaryMedicalCollege,themoresuccessfulandrespectedwomen’smedical
collegesI’vechosentofocuson.Blackwellstartedherschoolinresponseto
promptingfrompeopleandtopreventwomenfromenteringhomeopathyinstead.
ShebuiltitaftertheWMCPhadalreadybeenestablished.Therewerealso
differencesinfinancing–theWMCPinitiallyhadverylittlemoney,whileBlackwell
wasbackedbyanumberofdonors,andhadconnectionswithanumberof
influentialpeople.Despitethedifferenceinfinancialbacking,theWomen’sMedical
CollegeofPhiladelphiaandotherfemalemedicalcollegesupdatedtheircurricula
withinjustacoupleofyearsofBlackwell’sschool,andoftenwellaheadoftheAMA’s
67Wells,Susan.OutoftheDeadHouse:Nineteenth-CenturyWomenPhysiciansandtheWritingof
Medicine.Madison:UniversityofWisconsinPress,2001.62.
68Morantz-Sanchez,ReginaMarkell.SympathyandScience:WomenPhysiciansinAmericanMedicine.
NewYork:OxfordUniversityPress,1985,76.
34
mandatorycurricularchanges.69Risingstandardsofeducationinwomen’smedical
collegeswerematchedbyrisingstandardsofentrance.StudentsenteringtheWMCP
wererequiredtopresentadiplomaortakeanentranceexamin1871.TheWMCP
andtheNewYorkInfirmaryweretwoofthesixschoolstorequireafour-year
courseby1893,wellbeforebeingmandatedtodoso.70
MedicaleducationchangedinthewakeoftheCivilWar,aslandgrant
institutionsarose,andhadcoeducationintheircharters.Manyofthefirst
institutionstoacceptwomenwerethereforenewlyfounded.Otherschoolswere
forcedtoacceptwomenduetofinancialconstraints,anotableexamplebeingJohns
Hopkins.WhilethemaindonorandnamesakeofJohnsHopkinswasincredibly
wealthy,moneyhadrunoutbythetimethemedicalschoolwascreated.
Furthermore,investmentsintheBaltimoreandOhioRailroad,whichwere
expendedtofundthemedicalschool,didnotprofitasmuchasexpected.71Agroup
ofwealthyBaltimorewomenwhosefathersweretrustees,startedanationwide
committeetofundthemedicalschool,andthesefundsweregivenonlyunderthe
conditionofcoeducation.Oneofthemostgenerousdonorsgavemoneyunderthe
conditionofhighadmissionsrequirements,andconsequentlyJohnsHopkinswas
thefirstmedicalschooltorequireabachelor’sdegreepriortoentrance.72
Withtheriseofcoeducationcametheveryrapiddemiseofexclusively
femalemedicaleducation.Morantz-Sanchezattributestheclosingoffemalemedical
69Ibid.
70Ibid.
71Morantz-Sanchez,ReginaMarkell.SympathyandScience:WomenPhysiciansinAmericanMedicine.
NewYork:OxfordUniversityPress,1985,86.
72Ibid,83-87.
35
schoolspartiallyto“mountingfinancialburdensengenderedbythecostsofmedical
educationinanewscientificage,”aswellasthehopethatcoeducationwouldbe
abletotakeover.73Thenetworkoffemalephysiciansthathadallowedforrapid
growthearlyondeteriorated,asfewerwomen’sinstitutionswereopen,and
studentsincreasinglychosetostudyatcoeducationalinstitutions.Still,thoughthe
doorsofthefacilitieswerenowopentosomewomen,theirexperienceswere
nonethelessquitedifficult.Subsequentfemalephysiciansoftenfeltmoreisolated.
Thenumberofapplicantsandgraduatesalsodecreased,asmedicalcollegesoften
institutedofficialandunofficialquotasonhowmanyfemalestudentstheywould
accept,oftenaround5%ofmatriculants.74ExamplesofthisincludeHarvardand
Stanford,amongothers.75Bythe1890’s,however,morewomenstudiedin
coeducationalmedicalschools,sometimesmakingupalargepercentageofthe
graduatingclass.Forexample,AliceHamilton’sgraduatingclassfromtheUniversity
ofMichigan,whereshestudiedafterleavingtheFortWayneCollegeofMedicine,
consistedofanunusuallyhighproportionoffemalestudents,(fourteenoutoffortysevengraduates).76However,evenatallegedlycoeducationalinstitutionssuchas
Michigan,classeswereoftensegregated,andmanyschoolscontinuedtoexclude
womenstudentsfromurologyclinics.77Coeducationalsoresultedinthelossofthe
73Ibid,87.
74Morantz-Sanchez,ReginaMarkell.SympathyandScience:WomenPhysiciansinAmericanMedicine.
NewYork:OxfordUniversityPress,1985,86.
75"OverviewofWomenPhysiciansintheUnitedStates."InWomeninMedicalEducation:An
AnthologyofExperience,editedbyDeleseWear,byLeahJ.Dickson,4-5.NewYork:StateUniversityof
NewYorkPress,1996.
76SichermanandHamilton,34.
77Morantz-Sanchez,ReginaMarkell.SympathyandScience:WomenPhysiciansinAmericanMedicine.
NewYork:OxfordUniversityPress,1985,71.
36
networkofsupportthathadbeengeneratedinfemalemedicalcollegesandthe
broaderwomanphysiciancommunity.
Sodidthemeteoricriseofwomenphysiciansoccuraftertheimpedimentsto
medicaleducationhadbeentechnicallyremoved?No,despitethehopesofearly
pioneerssuchasElizabethBlackwellandMaryPutnamJacobi,whofeltthat
coeducationwouldbethekeytocompletelyintegratingwomenintotheprofession.
Whilesomeschoolscontinuedtorefusetoadmitwomenentirely,otherstook
womenasupto(andnomorethan)10%oftheirmatriculants.Thisisparticularly
notableinlightofthefactthatwomenapplicantswereonthewholemorequalified
thantheirmalecounterparts–DeanMeyersofIndianaUniversityadmittedthat“’a
higherpercentageofwomenwhopresentthemselvesformatriculationinmedical
schoolsarewellpreparedforthestudyofmedicine.’”78Therewasalsoashiftas
medicalschoolsbeganplacingsizelimitsontheirclassesratherthanacceptingall
qualifiedstudents,whichmadeadmissionmorecompetitive.Inthelightofthe
institutionaldiscriminationdisplayedbymanyofthesemedicalschools,itbecame
evenharderforqualifiedfemaleapplicantstogainadmission.
Therewerealsootherfactorsatplaythatlimitedthenumberofwomen
medicalstudents.Whileall-femalemedicalschoolshadcloseddown,andothershad
openedtheirdoorstomenandwomeninunequalmeasure,thenatureofmedical
educationitselfalsochanged,asrequirementsforapplicantsbecamemore
stringent.Moreandmoreschoolsrequiredabachelor’sdegreeuponentry,and
medicaleducationbegantoincludeaninternshipandresidencyfollowing
78Ibid,331.
37
graduation,leadingtoaverylengthyandhighlystructuredprocessforwomento
undergo.Additionally,fewerwomenwerefinanciallysupportedinthewaythat
theirmalecolleagueswere–oftenfamiliesdidnotwanttopayforthemedical
educationofdaughters,whiletheywouldbewillingtodosoforsons.Fewerwomen
couldworktosupporttheirmedicaleducationascostsrose.Additionally,atatime
whenmoreandmorewomenwerechoosingtomarry,andoftendroppingtheir
professionalcareersbecauseofit,fewerwomenwerechoosingmedicine.79This
issueofmarriagecauseddivisionsamongstfemaleprofessionals–among
physiciansespecially,somewomenbelievedthatphysiciansshouldnotmarry,but
bedevotedtotheirprofession,whileothersbelieveditwascompletelypossibleto
haveboth.Nonetheless,theburdenofcaringforthehouseholdandthechildren
usuallyresultedinsomesortofprofessionalcost,unlessfull-timeservantsand
child-careworkerswereenlisted,aswasoftenthecase.
Theargumentcouldbemadethatthesituationofdecliningfemale
participationwasnotuniquetothefieldofmedicine,butratheraconsequenceof
evolvingideasoffeminism,femininity,andviewsregardingone’shousehold
responsibilities.Thisargumentisquicklydisproven,however,whenacomparisonis
madewithotherprofessions–thenumberofwomeninlawschooldoubledand
thosereceivingPhDstripledwhileenrollmentofwomeninmedicineincreasedby
only16.7%(ascomparedtothe59%increaseinmaleenrollment).80
79Ibid,322.
80Morantz-Sanchez,ReginaMarkell.SympathyandScience:WomenPhysiciansinAmericanMedicine.
NewYork:OxfordUniversityPress,1985,314.
38
Thisshowsthatcoeducationwasnotthesolutiontocompleteintegration
thatElizabethBlackwellandothershopeditwouldbe.Infact,itseemsthatwomen
inmedicineactuallyregressedincomparisontowomeninotherfieldswith
comparableschooling,suchaslawandPhDsinvarioussubjects,aswellasin
comparisontomeninmedicine.
Femalemedicaleducationwascrucialinensuringthatwomenphysiciansdid
nothavetorelinquishtheirfemininityinordertopursuetheprofession,an
importantpointasmanyoftheseearlywomenphysiciansfelttheirfeminine
attributeswereacrucialpartofwhattheyofferedtotheprofessionthattheirmale
colleaguesdidnot.Italsoprovidedaframeworkofpersonalandprofessional
supportforthesewomenphysiciansatatimewhentheywereoftenmarginalizedin
theeyesofsocietyatlarge.
Notallfemalemedicalschoolswerereceivedpositively,asdemonstratedby
SamuelGregory’sNewEnglandFemaleMedicalCollege.However,whenthemedical
schoolsdemonstratedtheiradherencetotraditionallyacceptedmedical
methodologythroughupdatedcurricula,theywereabletoearnthereluctant
respectofthemedicalcommunity.Inordertomaintainthatrespect,however,
femalemedicalschoolsoftenheldthemselvestoamorerigorousstandardthan
theirmalecounterparts,whohadnothingtoprove.Thisdifferenceinstandardwas
reflectedindifferencesintestingdifficultybetweenElizabethBlackwell’sMedical
CollegeoftheNewYorkInfirmaryforWomenandChildrenandnearbymale
medicalschools.
39
FollowingtheCivilWarandsubsequentopeningofmedicalschoolsto
women,exclusivelyfemalemedicaleducationdiminished,acceleratedbythe
growingfinancialburdensofincreasinglyscientificandlaboratory-oriented
coursework.Coeducation,whileacleargoalofthefirstgenerationoffemalemedical
doctors,didnotprovetobeamechanismtocatalyzecompleteintegrationoffemale
physiciansintotheprofession,asmedicalschoolscontinuedtotreatmaleand
femalestudentsdifferently,whetherbysegregatingclasses,rejectingqualified
femalecandidateswhileacceptinglessqualifiedmalestudents,orbymaintaining
officialorunofficialquotasontheproportionsoffemalestudentsadmitted.
40
ChapterTwo:InvestigatingRhetoricalStrategiesofOpponentsandAdvocatesof
WomenPhysicians
41
Thepurposeofthischapteristoexaminefirst,theargumentsagainstwomen
physicians,andsecondly,howwomenphysiciansusedrhetoricalstrategiesto
counteroppositionandchangethewayinwhichwomenwereperceived.Inorder
fortheirwordstohaveresonanceandbetakenseriously,femalephysicians
constructedtheirprofessionalauthority.Therefore,wemustalsoexaminethe
importanceofthisauthorityandthewaysinwhichwomenphysiciansassertedit.
Physicians,bothmaleandfemale,usedrationalandscientificreasoningto
demonstratetheirexpertise,butwomenalsousedthisrhetoricasacountertothe
argumentthatfemininityandscientificlearningwereincompatible.Advocatesfor
womenphysiciansoftenreliedonthesameimplicitassumptionsaboutgenderas
theirdetractors,andturnedthisintoastrength—womenwerenaturallyempathetic
theyargued,andcould,throughmedicaltrainingbecomeexcellentphysicians.Men
ontheotherhand,lackedanymeanstoalleviatethesamegendernormsthat
presumedtheimproprietyofaphysicallyexaminingfemalepatients.Examiningthe
argumentsposedbycriticsoffemalewomenphysiciansaswellasthewaysinwhich
femaledoctorsandtheiradvocatesrefutedthoseargumentswillallowustobetter
understandsocialconceptionsoffemininity,theriseofmedicalprofessionalism,and
theperceivedincompatibilitybetweenthetwo.Wewillalsobeabletoseewhich
qualitiesoraspectsoffemininitywomenphysicianssoughttoemphasizeorerasein
anattempttoseemmoresuitedtothepursuitofscienceandprofessionalauthority.
Therewereanumberofcommonthreadsseenindifferentargumentsthat
opposedtheentranceofwomenintomedicine.Broadlyspeaking,thesecanbe
42
placedinthreecategories:biological,moral,andsocial.Biologicalarguments
claimedthatincreasedintellectualexertionofanykind,notjustinmedicine,would
resultinatrophyofthereproductiveorgans.Proponentsofbiologicalarguments
alsoarguedthatwomen’sgenderspecifichealthwouldnegativelyaffectthe
profession.Moralarguments,ontheotherhand,focusedoncharacterweaknessesof
women,suchasaninabilitytothinkrationallyandscientifically,andfocusedon
mentalfragilityasaninsurmountableobstacletotheirsuccess.Finally,social
argumentsdiscussedtheinevitablyruinousconsequencestocommunitiesand
societymorebroadlyofwomenabandoningtheirhomes,husbands,andchildren,in
pursuitoftheirprofession.Womenphysiciansusedacombinationofscientific
argument,classicalgenderroles,andadherencetoVictorianvaluesofmodestyand
privacytocounterthesearguments.
Itwasthought,forexample,thatover-educationandover-developmentof
thefemalebrainduringpubertywouldresultinimproperdevelopmentofthe
femalereproductiveorgans.Toprotecttheirhealthandadequatelyperformtheir
socialresponsibilityofreproduction,suchargumentsmaintained,womenshould
avoidnotonlythepracticeofmedicine,butalsoparticipationinallother
intellectuallydemandingendeavours.1Thisargumentrestedontheassumptionthat
thebodywasaclosedsystemofenergy.Ifmoreenergywasfocusedonintellectual
development,thenithadtobetakenfromsomewhere.Forwomen,itwasassumed,
theenergywasdrainedfromone’sreproductiveorgans.Followingthedeterioration
1Edward
H. Clarke. Sex in Education, or a Fair Chance for Girls. Boston: Houghton, Mifflin, and, 1884.
Smith-Rosenberg, Carroll, and Charles Rosenberg. "The Female Animal: Medical and Biological Views of
Woman and Her Role in Nineteenth-Century America." Women's Bodies. doi:10.1515/9783110976328.40.
339.
43
ofthereproductiveorgans,thewoman“wouldbecomeweakandnervous,perhaps
sterile,or…capableofbearingonlysicklyandneuroticchildren.”2Inthisway,
intellectualpursuitsendangerednotjustwomen,butalsoperhaps,societymore
broadly.
Fromthebeginningofthenineteenthcentury,physiciansandscientistswere
alsointerestedintheperceiveddifferencebetweenAmericanwomenandEnglishor
Europeanwomen,arguingthattheformerwerephysicallyinferior.3Thisdifference
wasoftenattributedtothefactthatAmericanwomenwereeducatedwithboys,and
increasinglydemandedaccesstohigherandevenprofessionaleducation.Male
physiciansinthe1870sfearedthattheeducationalactivismwouldonlyleadtoa
furtherdegenerationofAmericanwomen.4Becausesuchargumentsweremadeby
physicians,theyweregrantedauthoritybythegeneralpublic.Thesearguments
oftenreinforcedthebelief,mentionedinthepreviouschapter,thatthestudyof
medicineunsexedwomen.Ifthefemalesexwasdefinedbyreproductiveorgans,
theirdegenerationnecessarilyresultedinthedeteriorationoffemininenature.
EdwardH.Clarkeaddressedthisinhis1875pamphletSexinEducation;oraFair
ChanceforGirls.Clarkepositedtheidea,originallypartofHerbertSpencer’stheory,
thatthebodyisaclosedsystem,andsoeducation,particularlyduringfemale
adolescence,posedaseriousthreattothedevelopmentofahealthyreproductive
system:
Thesystemneverdoestwothingswellatthesametime.Iftheschoolmaster
overworksthebrainsofhispupils,hedivertsforcetothebrainthatis
2Ibid.340.
3Ibid,339.
4Ibid,340.
44
neededelsewhere.Hespendsinthestudyofgeographyandarithmetic,of
Latin,Greekandchemistry,inthebrain-workoftheschoolroom,forcethat
shouldhavebeenspentin…growth.Theresultsaremonstrousbrainsand
punybodies;abnormallyactivecerebration,andabnormallyweakdigestion;
flowingthoughtandconstipatedbowels;loftyaspirationsandneuralgic
sensations…Previouslytotheageofeighteenortwenty,opportunitymustbe
periodicallyallowedforthe[developmentofthereproductivesystem].Both
muscularandbrainlabormustberemittedenoughtoyieldsufficientforce
forthework.Ifthereproductivemachineryisnotmanufacturedthen,itwill
notbelater.Ifitisimperfectlymadethen,itcanonlybepatchedup,not
madeperfect,afterwards…Forcemustbeallowedtoflowthitherinanample
stream,andnotdivertedtothebrainbytheschool,ortothearmsbythe
factory,ortothefeetbydancing.5
Clarkeconcludedthatwhileitwaspossibleformenandwomentoattainthesame
knowledge,menmustlearninoneway,andwomeninanother.Astheargument
went,mengrowatasteadypace,whereasfemaleadolescencerequiredfocused
energyforthedevelopmentofthereproductivesystem.
Anotherprevalentbiologically-basedargumentheldthatwomen,whowere
considerednaturallyfrailandmoresusceptibletoillness,neededmedicalcaremore
frequentlythanmen,andthus,thatthedemandingprofessionofmedicinewould
weakentheirhealth.Thiswasconsideredtheconsequenceofboththeclosedsystemargumentmentionedabove,aswellasthephysicaldemandsofthemedical
profession.Thepressureofcompetition,withboththeirmaleandfemalepeers,left
thefemalecollegestudentsusceptibleto“hysteriaandneurasthenia.”6Edward
Clarkearguedthatwomencouldstudyjustaseffectivelyincollegesdesignedfor
men,butcouldnotatthesametime“retainuninjuredhealthandafuturesecure
5EdwardH.Clarke.SexinEducation;Or,aFairChanceforGirls.AccessedviaProjectGutenberg.
6Smith-Rosenberg,
Carroll, and Charles Rosenberg. "The Female Animal: Medical and Biological Views
of Woman and Her Role in Nineteenth-Century America." Women's Bodies.
doi:10.1515/9783110976328.40. 341.
45
fromneuralgia,uterinedisease,hysteria,andotherderangementsofthenervous
system.”7
Menandwomenwereseentobeintrinsically,physicallydifferent,withthe
femalebody“frailer,herskullsmaller,hermusclesmoredelicate.”8Thesecondof
thesecriticisms,thatofasmallerskull,wasespeciallyconvincingatthetime,given
thepopularityofphrenology.Thisscientificideologyarguedthatskullshapeand
sizewasreflectiveofintrinsicdifferencesincapabilityandintelligence.Phrenology
wasbasedontheideathatthebrainwastheorganofthemindandthattheskull
wasshapeduniquelytoaccompanythebrain,whichallowedforthedetectionof
intellectualcapabilitiesandpersonalitytraitsthroughpreciseskullmeasurements.9
Itswidespreadacceptance,bothpopularlyandscientifically,ledmanycriticsof
femalephysicianstousephrenologyasexplanationforthesupposedinferiorityof
notonlywomen,butalsonon-whites.Studentsofphrenologyarguedthatthe
measurabledifferencesinthefemaleskull’sdemonstratedthatwomenwere“far
moresensitiveandsusceptiblethanthemale,andextremelyliabletothose
distressingaffectionswhichforwantofsomebetterterm,havebeendenominated
nervous,andwhichconsistchieflyinpainfulaffectionsofthehead,heart,side,and
indeed,ofalmosteverypartofthesystem.”10Inotherwords,thenaturaldelicacy
thatcharacterizedwomencouldbemeasuredandreifiedbyphrenology.
7EdwardH.Clarke.SexinEducation;Or,aFairChanceforGirls.AccessedviaProjectGutenberg.
8Smith-Rosenberg,
Carroll, and Charles Rosenberg. "The Female Animal: Medical and Biological Views
of Woman and Her Role in Nineteenth-Century America." Women's Bodies.
doi:10.1515/9783110976328.40. 334.
9Bittel, Carla. "Woman, Know Thyself: Producing and Using Phrenological Knowledge in 19th-Century
America." Centaurus 55, no. 2 (2013): 104-30. doi:10.1111/1600-0498.12015. 105-106
10Ibid; Primary Source seen in Smith-Rosenberg, Carroll, and Charles Rosenberg. "The Female Animal:
Medical and Biological Views of Woman and Her Role in Nineteenth-Century America." Women's Bodies.
doi:10.1515/9783110976328.40.
46
Phrenologistsheldthatgenerally,“womenwereknownforexquisiteness,emotion,
susceptibility,and‘devotiontooffspring,’aswellastheirsecrecy,artifice,and
nervousness.”11
Whereasbiologicalargumentsagainstprofessionalwomencenteredonwhat
atthetimewereconsideredscientificgivens,moralargumentstendedtofocuson
femininepersonalitytraitsandtheirincompatibilitywithprofessionalism.Onesuch
argumentclaimedthatwomenmadedecisionsbasedonsentimentratherthanlogic
andreason,whichwereconsideredprerequisitesformedicalprofessionals.
JohannSpurzheim,forexample,arguedthat“womenexcelledinfeeling,menin
intellect,”implyingthatthetwoweremutuallyexclusive.Thissentimenthadits
rootsinEnlightenmentideasregardingrationality,andwasonlycompoundedwith
theriseofscienceofdifference.12Religion,andChristianityinparticular,directly
shapedmanyofthemoralargumentsagainstfemaleprofessionalism.TheFallof
Evewasoftenusedasanexampleofwomen’sweakwillandpoordecision-making,
furtherjustifyingtheirexclusionfromprofessionalcircles.Thesamebeliefs
ordainedwomen’straditionalrolesaswifeandmother,positingthemasdivinely
sanctioned.Suchbeliefssawwomendoctorsandprofessionalsingeneralasnotjust
unacceptable,butblasphemous.
Socialargumentsagainstfemalephysiciansrestedonthebroadercommunal
consequencesofwomenenteringthefieldofmedicine.Oneversionofthistypeof
argumentheldthatifwomenweretostopcaringforthehome,thenmenwould
11Bittel,
Carla. "Woman, Know Thyself: Producing and Using Phrenological Knowledge in 19th-Century
America." Centaurus 55, no. 2 (2013): 104-30. doi:10.1111/1600-0498.12015. 106.
12Ibid,107.
47
havetoreplacethem.Thewidespreadbeliefinseparatesphereideology—which
positedthehomeastheexclusivereserveofwomen—madesuchanideaseem
absurd,ifnotimpossible.Women,itwasassumed,wouldnotleavehometoworkin
suchademandingenvironment.This,ofcourse,ignoredallofthewomenwho
workedoutsideofthehome,aswellastheterribledemandsofmaintainingthelate
nineteenth-centuryhome.Anotherargumentinasimilarveindiscussedthe
ramificationsofmothersleavingchildrenbehindtogowork:Thiswouldresultnot
onlyinthechildrenbeingneglected,butalsointhefemalephysician’scontinuous
distraction,whichwouldadverselyaffectpatientcare.Thistypeofargument
assumedthatwomenwerethesolecaregiversforchildren,andalsothatpoorand
workingclasswomen,whohadnochoicebuttoearnaliving,didnotcare
adequatelyfortheirchildren.
Othersocialargumentsfocusedontheeffectsthatfemalestudentsand
physicianswouldhaveontheirmaleclassmatesandcolleagues.Menwere
presumedtobehavedifferentlyinthecompanyofwomenthanwheninahomosocialenvironment,andmalephysicianswerenodifferent.Opponentsofwomen
physiciansclaimedthatmalephysicians’behaviorwaslessconstrained,andthus
bettersuitedforthemedicalprofession,intheabsenceofwomen.13Malemedical
studentsatthetimewereoftenseenasboisterous,loud,andrambunctious,often
comingfromlowermiddleclassfamilies.Opponentsofwomenphysiciansfeltthat
thepresenceofladiesmightservetocurbthebehaviorofmalestudents.Whileit
13Skinner,Carolyn.StudiesinRhetoricsandFeminisms:WomenPhysiciansandProfessionalEthos
inNineteenth-CenturyAmerica.Carbondale,IL,USA:SouthernIllinoisUniversityPress,2014.
AccessedApril22,2016.ProQuestebrary,7-41.
48
wasnotclearhowthisaidedtheireducation,malemedicalstudentscloselyguarded
thesetraditionalhomo-socialenvironmentsnevertheless.
Asnotedinthepreviouschapter,thesesamesocialargumentsalsoposited
thatthestudyofmedicinemadefemalestudentsmoremasculine.Suchclaimsmay
havebeenmeanttocounterthecondemnationofmalestudentsinPhiladelphiawho
assaultedandharassedasmallgroupoffemalestudentsatahospitallecture.While
advocatesforthefemalestudentsclaimedthatthemandidnotactinagentlemanly
manner,thereciprocalaccusationwasoftenleveledatthewomen.Theanonymous
authorofthepamphletMenandWomenMedicalStudents,andtheWoman
Movementstatedplainly“Thereisprobablynoprofession,inthepreparationfor,or
thepracticeofwhichagreatertendencyexiststomake‘manlywomen,’thaninthat
ofmedicine,unlessweexceptthemilitary.”14Hegoesontosaythatwomenstudents
whohavetheirowncolleges,theirowninstructors,whenaskingtoenteramale
learningenvironment,that“’theynotonlywanttheirownrights,buttheywantour
rightsalso.’”15Theauthorofthispamphletemphasizedthattheproblemwith
womenstudyingmedicinewasintheimproprietyofthemstudyingintimate
physicalproblemsinthepresenceofmalestudentsandinstructors.Theauthordid
concedethatwomenmaystudymedicineiftheysochoose,buttheywoulddosoin
thefaceofa“verylargeandsensibleportionofthepeopleofthiscountry,bothmen
andwomen,[who]agreeintheopinionthatitisunwiseandinappropriatefor
womentobecomemedicalpractitioners.”16Theauthordrewtheline,however,at
14Men
and Women Medical Students, and the Woman Movement. Philadelphia, 1870. 6.
15Ibid,9.
16Ibid,9.
49
womenstudyingmedicinewithmen.Thisobjectionmadeclearthatformanythe
biggestproblemwithwomenstudyingmedicinewastheviolationofsocietal
proprietythatwouldoccuriftheyweretostudyinthepresenceofmen.
Somewomenmadesimilararguments,particularlywhendiscussingthe
intrusionofmenintochildbirth.Nevertheless,thosewhoheldthattherewasno
placeinmedicineforwomenquicklycounteredsucharguments.JohnMaubrey
argued:
MEN…beingbetterversedinAnatomy,betteracquaintedwithPhysicalhelps,
andcommonlyenduedwithgreaterPresenceofMind,havebeenalways
foundreadierordiscreeter,todevisesomethingmorenew,andtogive
quickerReliefinCasesofdifficultorpreternaturalBIRTHS,thancommon
MIDWIVESgenerallyunderstand.17
Maubreybelievedthattheskillofmale-midwiveswassuperiortothatoffemale
midwives.Hispointsaboutmenbeingmoreinnovativeandhavinggreaterpresence
ofmindreliedonfixedideasofmasculinityandfemininity,viewsthatwerebroadly
acceptedsocially,andincreasinglygiventheimprimaturofempiricalresearch,such
asphrenology.Becausemenwereseenasmoreself-possessedandwomenwere
subjecttonervouscomplaintsanddelicacy,itwasclearthateveninwhatseemed
clearlytobeawomen’sissue,mencouldclaimtobesuperiorproblem-solversand
caregivers.Maubreyandothersbelievedthatbecauseproblemsinchildbirth
occurredsofrequently,morewomenandfamilieswouldseektohaveamanmidwifeoraphysicianpresentatthebirthoftheirchildren.
17Primarysource,asseeninDonegan,Jane.""SafeDelivered,"butbyWhom?MidwivesandMen-
MidwivesinEarlyAmerica."InWomenandHealthinAmerica,editedbyJudithWalzerLeavitt,30218.Madison:UniversityofWisconsinPress,1984.
50
So,howdidfemalephysicianscountertheseopposingarguments?Initially,
theyusedinterestinglysimilarclaimstosupporttheirpositions.Medicalcarewas
linkedtothetaskofcaregiving,whichhadtraditionallybeen,manyargued,the
exclusiveprovinceofwivesandmothers.Itwasonlyinthemiddleofthenineteenth
centurywhenmedicinebecamemoreformalizedandprofessionalthatmenbegan
totakeovereventhoseareasofmedicinethathadbeforebeentheexclusivedomain
ofwomen—theemergenceofmalemidwivesprovidestheperfectexampleofthis.
Oneofthestrongestargumentsinsupportofwomenphysicianssuggestedthatthey
werenotonlyplausible,butalsoabsolutelynecessaryinordertoprovidemedical
caretowomenwhilerespectingtheirmodestyandobservingsocialnorms.This
argumentprovidedanimportantcounterweightagainsttheviolationofpropriety
thatwouldresultfromwomenseeingmalepatients’bodiesinthecourseof
treatment.18
Manyoftheadvocatesforfemalephysiciansemphasizedtheargumentthat
womendoctorsshouldandcouldcareforotherwomen.Thiswasespeciallytruein
theirdiscussionofchild-birth.Whileasignificantproportionofchildrenwere
deliveredbymidwives,theemergenceofforcepsandothertechnologicaland
methodologicaladvancescausedphysiciansandsurgeonstobeincreasingly
involvedintheprocess.Atfirst,theywereinvolvedonlywithdifficultor
troublesomebirths,laterextendingtheirreachtoprolongeddeliveries,and
eventuallyclaimingthatexpertknowledgewasneededforeverychildbirth.The
AmericanMedicalAssociationestablishedaSectiononPracticalMedicineand
18Morantz-Sanchez,
Regina Markell. Sympathy and Science: Women Physicians in American Medicine.
New York: Oxford University Press, 1985. 152.
51
Obstetricsin1859,laterrenamedtheSectiononObstetricsandGynecology.19
Beforeobstetricsemergedasavalidspecialty,itfellunderthepurviewofevery
physicianandgeneralpractitioner.Oppositiontomale-directeddeliverieswas
hardlyanovelphenomenon—SamuelWilliamForespublishedhisworkManmidwiferydissected;orthefamilyobstetric-instructorin1763,anddetailedinitthat
“Man-midwifery[was]apersonal,adomestic,andaNationalevil.”20
Womenphysicians’oppositiontomale-midwiferywassimilarinthatitfelt
thatmensupervisingtheprocessofchildbirthwasaviolationofsocietalvalues,and
incrediblyembarrassingforthepregnantwoman.However,theircriticismsdidnot
stopwithmalemidwifesorphysicians.Theyalsocritiquedmidwives,arguingthat
mostmidwiveslackedthepropereducationtopresideoverchildbirth.Their
presencecouldsatisfytheneedformodesty,butwouldpotentiallyresultin
generallyworseoutcomesduetolackofknowledgeaboutthebestprocedures,
whentouseforcepsandwhentowait,andignoranceaboutpotentialcomplications.
Thebestsolutiontotheproblemwastherefore,theyargued,tohaveawomanwith
apropermedicaleducation,supervisethedeliveryprocess,andeducateother
womenabouttheirbodies.Thisargumentdemonstratesthewaythatwomenoften
chosetoworkwithinthesystem,ratherthanfightingtochangesocietalnorms.They
reliedonandevenreinforcedthesameideasofgenderandmodestythatwereused
tobarthemfrommedicalpractice.
19Borst,
Charlotte G. "The Professionalization of Obstetrics." In Women, Health, and Medicine in America,
edited by Rima D. Apple, 203. New York: Garland Publishing, 1990.
20S.W.Fores.Man-MidwiferyDissected;Or,theObstetricFamily-instructor.FortheUseofMarried
Couples,andSingleAdultsofBothSexes...InFourteenLettersAddressedtoAlex.Hamilton...Occasioned
byCertainDoctrinesContainedinHisLetterstoDr.W.Osborn.London,1793.173
52
SophiaJex-Blake,oneoftheearliestfemaleEnglishphysiciansandamongst
thefirstgroupoffemaleundergraduatestostudyataBritishuniversity,tracedthis
historicaltrajectoryofmidwifery.Shearguedthatwomenheldpositionsinmedicalrelatedfieldsasmidwivesforcenturiesbeforemenbegantoquestiontheir
authority.ShecitedMargaretCobbeasthefirstmidwife,highlightingCobbe’syearly
salaryfromtheCrownstartingin1469.21Jex-Blakeattributedtheentranceofmen
intoBritishchildbirthtothepooreducationoftheirfemalemidwives.She
supportedthisassumptionbypointingtocontinentalEurope,where,“owingtotheir
bettereducation,themidwivesretainmuchofthepositionthattheyhaveforatime
lostinEngland.”22Americanmidwives,likewise,hadlosttheirsocialposition,dueto
theirinsufficienteducation.23ShealsopointedtotheexampleofRussia,where“’a
medicalmanisveryrarelycalledin;notwithstanding,fatalcasesareoffarless
frequentoccurrenceinRussiathaninEngland.’”24Jex-Blakesuggestedthatwith
properlytrainedfemalephysiciansandmidwives,maleoversightofbirthwas
unnecessary,andthattreatmentbyacompetentfemalemidwifewouldoftenresult
inmorepositiveoutcomes.25
HistorianFrancesE.KobrinfurtherilluminatedtheplightoftheAmerican
midwife.WhileJex-BlakespenttimetrainingintheUnitedStates,shewaswritingto
aprimarilyEnglishaudience,andsoaddressedprimarilyEnglishsituations.Kobrin
examinestheAmericanmidwife,whowasalso,sheargues,plaguedbypoor
21Jex-Blake,
Sophia. Medical Women: A Thesis and a History. New York: Source Book Press, 1970.
16.
22Ibid. 26.
23Ibid,27.
24Ibid
25Ibid
53
education,socioeconomicobstacles,andincrediblyhighratesofinfantmortality
andpreventablematernaldeathsduetopuerperalsepsis,aswellashighratesof
neonatalophthalmia.26Kobrinarguesthatwhilealmostfiftypercentofbirthswere
attendedbyamidwife,manywerealsosupervisedbygeneralpractitioners.
Importantlyandcontrarytoargumentsbeingmadebymalephysicians,theresults
obtainedbygeneralpractitionerswerenotsignificantlybetterthanthoseobtained
byfemalemidwives.Whenfemalemidwiveswerechosen,theyoften“sharedrace,
nationality,andlanguagewiththeircustomers”,animportantfactorconsidering
one-thirdofthenation’spopulationwascomposedofAfricanAmericansandrecent
immigrants.27HistorianNancyTheriotarguesthatthosewomenandfamiliesthat
turnedtomalephysiciansforchildbirth“hopedtohavesaferandlesspainfulbirth
experiences…[but]thechildbirthexperiencewasactuallyfullofnewdangersand
newsourcesofpainandanxiety.”28Thenewsourceofanxietywas,Theriot,often
linkedtotheembarrassmentofbeingseenbyamanintheintimatesituationof
givingbirth.
Counteringtheargumentthatwomenwereunsuitedtomedicalworkby
virtueoftheirinnatedelicacy,Jex-Blakecitedtheuniversalapprovalthatmet
FlorenceNightingale’swork.Nightingalewasanurse,andwaswellknownforher
workduringtheCrimeanWar.SheandElizabethBlackwellsharedalongand
26Leavitt,
by Frances E. Kobrin,"The American Midwife Controversy: A Crisis of Professionalization." In
Women and Health in America: Historical Readings, edited by Judith Walzer and Ronald L. Numbers.
Madison, WI: University of Wisconsin Press, 1984. 218.ElizabethBlackwellalsolostmuchofthevision
inherleft(?)eyeduetoneonatalophthalmiainfectionafterhandlingasickinfant.Neonatal
ophthalmiawasdefinedastheoccurrenceofconjunctivitis(alsoknownaspinkeye)withinthefirst
monthoflife.
27Ibid, 217.
28Theriot, Nancy M. Mothers and Daughters in Nineteenth-century America: The Biosocial Construction
of Femininity. Lexington, KY: University Press of Kentucky, 1996. 52.
54
complexrelationship,beginningwiththeirsharedinterestintheroleofwomenin
medicineaswellastheiradvocacyforincreasedhygieneandsanitationin
healthcare.Theirrelationshipeventuallygrewdistantastheyarguedoverthe
proposedlocationofaproposedwomen’shospital,andBlackwelllaterrefusedto
serveassuperintendentofNightingale’sschoolofnursing.Nightingaledescribed
theirdifferencesasBlackwellattemptingto“educateafewhighlycultivated
[women]—[andherself]todiffuseasmuchknowledgeaspossible.”29Nightingale
wasverywellregardedbyEnglishsociety,whichJex-Blakeusedtofurtherher
argumentforwomenphysiciansinherworkMedicalWomen:AHistoryandaThesis:
WhilealmosteverybodyapplaudsandrespectsMissNightingaleandher
followersfortheirbravedisregardofconventionalitiesonbehalfofsuffering
humanity,andwhilehardlyanyonewouldpretendthattherewasanywant
offemininedelicacyintheirgoingamongthefoulestsightsandmostpainful
scenestosuccour,nottheirownsex,buttheother,manypeopleyetprofess
tobeshockedwhenotherwomendesiretofitthemselvestotakethemedical
careoftheirsisterswhowouldgladlywelcometheiraid.30
Jex-Blakeusedthistypeofrhetoricthroughoutherbooktojustifyfemale
physicians.ThepublicadmiredFlorenceNightingale’snursingwork,andasJexBlakemadeclear,contrarytopopularopinion,Nightingaleandherfollowersoften
exposedthemselvestodecidedlyun-delicatesightsandsoundstoattendto
woundedmen.DespitethefactthatNightingale’scareforwoundedmenflewinthe
faceofVictorianidealssurroundingmodestyandtheexposureofbodies,England
celebratedherwork.Therefore,Jex-Blakeargued,thereactionthatwomen
physiciansreceivedwasdisproportionatelynegative.Sheargued,infact,that
29Boyd,
Julia. "The Art of Medicine: Florence Nightingale and Elizabeth Blackwell." The Lancet. May 2,
2009. Accessed March 7, 2016. doi:http://dx.doi.org/10.1016/S0140-6736(09)60845-X. 1516
30Jex-Blake, Sophia. Medical Women: A Thesis and a History. New York: Source Book Press, 1970. 40,
55
receptiontofemaledoctorsshouldbemorepositivethanMissNightingaleandher
disciplesreceived,giventhattheydidnotseektoviolatesocialnormstothesame
extent.
Tocounterbiologicalargumentsregardingwomen’sphysicalinabilitytodeal
withthestressesofpracticingmedicine,womenusedcounterexamplessuchas
washerwomentoprovethatlaborinitselfwasnotdetrimentaltofemalehealth.31
Theyinsteadattributedthephysicalandmentalailmentsthatweresorampant
amongstAmericanwomentosocietalfactorssuchasoverlyrestrictiveclothingand
asedentarylifestyle.Dr.AliceStockhamdrewthedistinctionclearly,statingthat
“girlsandwomencanbearstudy,buttheycannotbearcompressedviscera,tortured
stomachs,anddisplaceduterus,”symptomsthatweredirectlyattributableto
fashionableclothing.32Stockham’sargumentdrewdirectlyonherauthorityasa
physiciantocriticizesocietalnorms,anddoingso,exoneratedwomenfromtheidea
thattheyarephysicallyincapableofsignificantmentalandintellectualexertion,
whiledemonstratingtheircapacitytomakescientificarguments.
Womenusedtheverysamescientificreasoningofwhichtheywereallegedly
incapabletorefutethebiologicallybasedargumentsoftheiropponents.Atthistime,
thefieldofstatisticshademergedandwasincreasinglyusedinscientific
publications,andsowomenphysiciansturnedtothesametool.Similarlyinclined
womenscientistsconductedsurveyssentouttolargegroupsofwomenphysicians,
pollingthemontheirphysicalhealthpriortopracticingmedicineascomparedto
31Smith-Rosenberg,
Carroll, and Charles Rosenberg. "The Female Animal: Medical and Biological Views
of Woman and Her Role in Nineteenth-Century America." Women's Bodies.
doi:10.1515/9783110976328.40. 342.
32Ibid343.
56
theirhealthafterfiveyearsofpractice.Asimilarsurveywassentoutinquiringinto
women’sself-reportedsatisfactionattheirperformanceasmothersandwives,with
asizablemajorityreportingthattheyfelttheirprofessionhadapositiveeffecton
theirdomesticlives.33Thesetypesofrebuttalswereparticularlyclever,asthey
forcedacceptanceofwomenasrational,scientificminds,andalsodemonstratedthe
fallacyoftheassumptionsthatprofessionalemploymentwouldnegativelyinfluence
theirphysicalhealthordomesticroles.
Similarly,someadvocatesoffemalemedicalpractitionersembraced
phrenologytomaketheircase.Attheheartoftheirargumentslaythefactthatmen
andwomenhadallthesameorgans,thoughtheydifferedinsizeanddevelopment.
Thismeantthatwomenhadthepotentialtobedoctors(andprofessionalsin
general),andthroughintentionaldevelopment,couldacquirethesamereasoning
andscientificskillsthatmalephysicianshad.34Professionaltraining,theyargued,
didnotnecessarilymeanrenouncingfemininevaluessuchascompassion.Infact,
thecombinationofmasculine-genderedscientificknowledgewiththeinnately
femininecompassionwasposedassomethingthatonlywomenphysicianscould
offerthemedicalcommunity.
ElizabethBlackwellandLydiaFolgerFowler,thefirstandsecondfemale
M.D.sintheUnitedStates,bothpracticedphrenology.HistorianCarlaBittel
describesFowlerasusing“phrenologytocreatescientificrolesforwomen,making
33SkinnerForty-fouroffifty-twosurveyedfelttheirprofessionbenefittedtheirdomesticlives.
34Bittel,
Carla. "Woman, Know Thyself: Producing and Using Phrenological Knowledge in 19th-Century
America." Centaurus 55, no. 2 (2013): 108. doi:10.1111/1600-0498.12015.
57
themkeepersofscientificknowledge,insideandoutsideofthehome.”35Inactively
partakinginphrenology,womenwereabletomanipulateitsconclusionsand
interpretations.Doingsoalsodemonstratedtheirabilitytothinkrationally.Many
well-knownfeministssuchasLucretiaMottandElizabethCadyStanton,aswellas
femalephysiciansincludingElizabethBlackwell,HarriotHunt,andLydiaFolger
Fowlerwerefollowersofphrenology,allofwhomarguedthatthesubtlebutdistinct
femaletraitsphrenologyexplainedwerehelpfulandusefultosociety,andthat
womendeservedequalrightsonthebasisoftheiressentialequality.36
Linesofargumentcenteringaroundfemalestudents’civilizingeffectwere
madeveryclearintheeditorialresponsestotheJeeringIncidentmentionedinthe
previouschapter,inwhichagroupofstudentsfromtheWomen’sMedicalCollegeof
Philadelphiawereharassedbyagroupofmenwhentheyattendedahospital
lecture.Opinionsthatsupportedthefemalestudentsoftendidsobyclaimingthat
womenhadacivilizingandhumanizinginfluenceonmalemedicalstudents,known
throughoutPhiladelphiasocietyatleastfortheircrudenessandraucousbehavior.37
Supportersoffemalemedicalstudentdenigratedtheun-gentlemanlyconductofthe
maleharasserswhileextolingtheladylikeproprietyofthefemalestudentsand
physicians.
Someadvocatesforfemalephysiciansarguednotagainstanyofthe
individualconsequences—theperversionoffemininepurityormodesty—but
35Ibid,112.
36Ibid.
37Skinner,Carolyn.StudiesinRhetoricsandFeminisms:WomenPhysiciansandProfessionalEthos
inNineteenth-CenturyAmerica.Carbondale,IL,USA:SouthernIllinoisUniversityPress,2014.
AccessedApril22,2016.ProQuestebrary,26
58
againsttheverypremisesuponwhichtheoppositionalargumentswerebased.The
consequencesmanyfeared,wereunlikely,theyargued,becausemedicineitselfwas
anoblepursuit,onetoopuretobesexualizedorsociallyproblematic.Infact,
becausethepursuitofknowledgewascerebral,tobepursued,theyargued,bythe
genderlessmind,tosuggestsuchconcernspervertedanotherwisehighercalling.38
Thosemedicalstudentsorphysiciansthatclaimedthattherewassomething
uncleanorsexualaboutmedicinefundamentallymisunderstoodthenatureoftheir
work.Aneditorialclaimed:
Ifallmedicalstudentscouldbeendowedwithaproperconceptionofthe
worktheyhaveinhandtheywouldquicklypartwithallrestricting
observances,wouldbetransportedtothatidealspherewheremindholds
communionwiththeInfinite…andwherenouncleanthoughtisallowedto
enter.39
Aswellasnegativeargumentscounteringopponents’points,women
physiciansalsoofferedpositiveargumentsontheirprofessionalnecessity.Alarge
partofthesepositiveargumentscenteredoncounteringthenegativeeffectsof
modestyonwomen’shealth,duepurelytothereluctanceofwomentospeakto
maledoctorsaboutembarrassingordelicatemedicalcomplaints.Jex-Blake
addressedthistopicinherthesis:
OftheBostonHospitalforWomenandChildrenIcanspeakfromlengthened
experienceinitasastudent.WhenstandinginitsdispensaryIhaveoverand
overagainheardroughwomenofaverypoorclasssay,whenquestioned
whytheyhadnothadearliertreatmentforcertaindiseases,“Oh,Icouldnot
gotoamanwithsuchatrouble,andIdidnotknowtilljustnowthatladies
didthiswork;”andfromothershaverepeatedlyhearddifferentexpressions
38Ibid,27.
39Editorial,Press,seeninSkinner,Carolyn.StudiesinRhetoricsandFeminisms:WomenPhysicians
andProfessionalEthosinNineteenth-CenturyAmerica.Carbondale,IL,USA:SouthernIllinois
UniversityPress,2014.AccessedApril22,2016.ProQuestebrary.27.
59
ofthefeelingthat,“It’ssonice,isn’tit,tobeableatlasttoaskladiesabout
suchthings?”40
Thisintroducesanelementofclasstothediscussion—Jex-Blakearguesthatnot
onlydowomenhelpotherwomen,butthateducated,financiallysecurewomenhelp
lessfortunatewomen,“womenofaverypoorclass.”
Thiswasastrongargumentbecauseithighlightedthecharitablenatureof
medicine,whichwomenweretraditionallyknownandcelebratedforbothinside
andoutsidetheprofession.Jex-Blakealsonoted“casesconnectedwithstoriesof
shameorsorrowtowhichawoman’shandcouldfarmostfittinglyminister,and
wheresisterlyhelpandcounselcouldgivefarmoreappropriatesuccorthancould
beexpectedfromtheaverageyoungmedicalman.”41Thisagainappealedtothe
desire(andexpectation)ofwomentohelptheirlessfortunatesisters.Usingthe
word“minister”broughttomindreligion,asdidthewordsisterlywhichevoked
imagesofasisterhoodsimilartothatamongstnuns.Referringtoreligiousvaluesof
charitywasaneffectivecountertotheargumentthatwomenwerenotsuitableto
medicineduetotheirdivinelyordainedsocialrolesaswivesandmothers.
Finally,womenphysicianswereabletonegateargumentsthattheywere
unabletothinkscientifically,bydoingscientificresearchthattheypresentedtoa
muchbroaderaudience.MaryPutnamJacobiwasperhapsthemostwellrespected
ofthefirstgenerationofwomenphysicians,andthiswas,inpart,duetoheruseof
rationalreasoningandscientificmethod.Herpublicationscontributednotonlyto
40Jex-Blake,
Sophia. Medical Women, a Thesis and a History. I. Medicine as a Profession for Women. II.
The Medical Education of Women. I. The Battle in Edinburgh. II. The Victory Won. By Sophia Jex-Blake.
Edinburgh: Oliphant, Anderson, & Ferrier, 1886. 43-44
41Ibid,44.
60
thescientificandmedicalcommunities,butwerewrittenforpopularaudiences.42
AliceHamilton,sometimelater,managedtomakesosizableacontributiontothe
fieldoftoxicologythatshebecamethefirstfemalefacultymemberofHarvard
MedicalCollege.ItwasclearthatHarvardpreferrednottohireher,butdidso
becauseherexpertisefaroutstrippedtheperceiveddisadvantageofhergender.43
Manyofthescientificargumentswomenmadeintheirdefensereliedon
demonstratingtheirexpertiseandauthority.Whywasauthorityimportant?
‘Scientific’argumentsagainstfemalephysicianspublishedbymalephysiciansand
scientistsweregivencredencebysocietyduetotheperceivedexpertiseofthe
authors.Byusingthesameprofessionalrhetoricandreasoning,womenphysicians
wereabletocounterthesearguments.Moreimportantly,theirtreatisesandarticles
allowedthemtousethescienceofmedicinetoinfluencesocialperceptionsof
womeningeneral,shapingandinfluencingthemedical,sexual,andsocialeducation
ofwomenthroughoutthenation.Becausewomenphysicianstypicallyexperienced
difficultyinconvertingtheirmalecolleagues’opinions,theyinsteadturnedtothe
middleclassasawhole.44Theireffortsslowlyworkedtoalterperceptionsof
professionalwomen,andreshaping,ifnotrejecting,presumedgendernorms.This
strategyreflectedtheirdesiretobeacceptedbysocietyasawhole,whichwould
providethemwithsocialandeconomicstability.Ofcourse,theystillpursuedthe
42Morantz-Sanchez,ReginaMarkell."SeparatebutEqual:MedicalEducationforWomen."In
SympathyandScience:WomenPhysiciansinAmericanMedicine,73.NewYorkCity,NY:Oxford
UniversityPress,1985.190.
43Morantz-Sanchez,ReginaMarkell."SeparatebutEqual:MedicalEducationforWomen."In
SympathyandScience:WomenPhysiciansinAmericanMedicine,73.NewYorkCity,NY:Oxford
UniversityPress,1985.313-14.
44Skinner,Carolyn.StudiesinRhetoricsandFeminisms:WomenPhysiciansandProfessionalEthos
inNineteenth-CenturyAmerica.Carbondale,IL,USA:SouthernIllinoisUniversityPress,2014.
AccessedApril22,2016.ProQuestebrary,33.
61
acceptanceofmalephysicians,whichwouldresultinmoreprofessional
opportunitiesandperceivedprofessionalgenderequality.
Thewrittenworkofwomenphysicians,andtheirrepresentationsmadeby
themselvesandothers,allowsustoviewhowthedoctorsandscientistsfeltthey
shouldbeportrayed.Often,thefirstexampleofmedicalwritingaphysician
publishedwasamedicalschoolthesis.Thesesoftenreflectedtheinterestsofthe
physicians,bothintermsofthepopulationsofinterestandthefavoredmedical
ideology.Forexample,ElizabethBlackwellwroteonthetreatmentoftyphus,a
diseasewhichdisproportionatelyaffectedthepoor,goingontospendmostofher
careertreatingpoorwomenandchildren.45Womenphysicianswereencouragedto
writethesesmoreoftenthantheirmalecounterparts.Furthermore,theyweremore
frequentlyedited.Edits,frequentlymadebymaleprofessors,oftendidnotserveto
substantiallyalterthemeaningofthework,suggestingthateventhemenwhowere
opentotheideaofwomendoctors,whoactivelyworkedtomakethisideaareality,
continuedtomanifestsubconsciousjudgmentsontheirwritingabilities,while
equivalentjudgmentswerenotmadeaboutmalestudents.46SusanWellsexamined
thethesesofstudentsfromtheWomen’sMedicalCollegeofPhiladelphiawere
comparedtothoseofJeffersonMedicalCollege,bothlocatedinPhiladelphia,and
theywerecomparedtoseehowmuchtheywereedited.Thissuggeststhatthey
werebeingmorecloselyscrutinizedthantheirmalepeers.47Followingthe
45Blackwell,
Elizabeth. Pioneer Work in Opening the Medical Profession to Women; Autobiographical
Sketches. New York: Source Book Press, 1970. 81.
46Wells,Susan.OutoftheDeadHouse:Nineteenth-CenturyWomenPhysiciansandtheWritingof
Medicine.Madison:UniversityofWisconsinPress,2001.82.
47Ibid.
62
curricularshiftoftheWomen’sMedicalCollegeofPhiladelphia,HannahLongshore,
sister-in-lawofthedisgracedJosephLongshore,disguisedthehydropathiccontent
ofherthesisthroughstrategiceditingofitstitle.48
Womenphysiciansputagreatdealofthoughtintohowtheypresented
themselvestotheprofessionasawhole.Theyhadanumberofdifferentwaysof
takingownershipoftheirwork–sometimeswomensignedofftheirscientificwork
usingtheirinitials,thefirstinitialandlastname,theprofessionalprefixofDr.or
suffixofM.D.SometimestheyevensignedoffasMrs.Examiningthedifferentforms
ofself-presentationallowsustoseewheredifferentauthorsderivedtheirauthority.
Forexample,anauthorwhosignedoffasMrs.advisingwomenonthecorrectways
toswaddletheirbabiesderivedherauthoritynotasaprofessional,butasamarried
woman,andpresumably,asanexperiencedmother.UtilizingDr.orM.D.reflecteda
desiretouseone’sprofessionalidentityasasourceofauthorityandlegitimacy.Use
ofinitials,ontheotherhand,aimedforauthoritybyvirtueofdisguisingone’ssex.
Useofinitialswasnotonlylimitedtohowthewomenphysicianssignedtheir
work,butalsohowtheyappearedondocumentswrittenbyothers—Elizabeth
BlackwellwasdesignatedE.Blackwellonanofficialrosterof1848graduatesof
GenevaMedicalCollege,betweenPaytonDunwoodieBeecherandJohnBrant.49This
demonstratesthewaythemale-dominatedmedicalschool,whichrefused
subsequentfemaleapplicants,attemptedtoeraseBlackwell’sfemininityand
presence.
48Ibid,104.
49GenevaMedicalCollege1848Circular,AccessedatSUNYUpstateMedicalUniversity
63
Womenphysicianswereabletousethesamemethodsusedbytheir
opponentstoprovetheywereneeded.Wheretheiropponentsusedphrenologyto
provethemphysicallyandmentallyincapableofthestrenuousintellectuallaborof
medicine,womenphysiciansusedphrenologytoprovetheyhadthesamecapacities
asmen,andcouldworktodevelopthemifneeded.Wheremenusedscientific
reasoningtoexcludethem,womencircumventedthoseargumentsinthesameway.
Bysimultaneouslyreifyingandsubvertinggenderedexpectationsofbehavior,
womenphysicianswereabletomakethecasethattheywerenotonlycapable,buta
necessarypartofthemedicalprofession.
64
Chapter3:WomenPhysicians’PrescriptionsandExperiencesofFemininity
65
Thischapterservestodiscussthemotivationsandaimswomenhadfor
enteringtheprofessionofmedicine,andthentoanalyzetheimpactandchanges
theysoughttomakeinmedicineandinsocietyasawholeasphysicians.Generally
speaking,womenphysicianssoughttochangethewaysinwhichwomenraisedand
educatedtheirchildren.Therewereanumberofsocialreformcausestakenupby
womenphysicians,includingdressreform,temperance,andeducationalreform.
Blackwellherselfwroteextensivelyontheeducationofgirls.Sheaimedtoteach
mothershowtoeducatetheirdaughtersaboutsex.
Theemergenceofwomenphysiciansinthenineteenthcenturyoccurred
withinawidercontextofsocietalchanges,oneofwhichwasamovetowardsmass
industrialization.Whereaspreviously,themajorityoflaborwasunwaged(often
agriculturalordomesticlabor),increasingindustrializationandurbanization
resultedintheincreaseofwagelabor.JeanneBoydstonarguedinherbookHome
andWorkthattheriseofwagedlaborledtothediminutionofthevalueofunpaid
labor.1Thisdisproportionallyaffectedwomen’slabor.Whilesomewomenworked
infactoriesandearnedwages,theywerealsoresponsiblefordomesticlaborand
childrearing.Theunpaidnatureofthesetasks,despitetheirrigorousnature,ledto
theirbeinglessvaluedbysociety.Thisinturnfosteredtheideathatwomenwho
wereperformingexclusivelydomesticandchildrearinglaborwereinfactnotuseful.
Thiscultivatedinwomenastrongdesiretobeofuse.Manywomenaccededtothis
1Boydston, Jeanne. "Home & Work: Housework, Wages, and the Ideology of Labor in the Early
Republic." Journal of Interdisciplinary History 22, no. 4 (1992): 750. doi:10.2307/205258. 30
66
desirebypursuingworkoutsidethehome,whetherthatwasinfactories,waged
laborsettings,orinaprofessionalsettingsuchasmedicine.2
Manywomenphysicianscitedthisdesiretobeusefulasamotivatingfactor
forchoosingmedicine.ElizabethBlackwell,whendiscussingtheprocessofchoosing
aprofession,wroteofherdesiretofindausefulone.3AliceHamiltonwrote,when
weighingmedicineagainstotherprofessions,ofbeingabletobeofuseanywhere,
addingthefactorofmobilitytoherconsideration.4
CathyLuchettidiscussesthemotivationsmanywomenphysicianshadfor
enteringthefieldinMedicineWomen:TheStoryofEarly-AmericanWomenDoctors.
Beyondthedesiretoservethecommunity,manywomenweredrivenbythedesire
tolearn.Othershadanursingbackgroundandfeltitwasthenaturalprogressionto
gointomedicine.Therewasalsooftenarolemodel,eitheranolderwomandoctor,
oramalemedicalinfluence.Manywomendoctorshadfathersorbrotherswhowere
alsoinmedicine,andservedastheirprimaryinspiration.Interestingly,some
womenendeduppursuingmedicineinordertoaidtheirphysicianhusbands.This
seemsatoddsconsideringthatmedicinehadbeenportrayedasacompetingforce
withmarriage,ratherthanacooperativeone.However,inthesparselypopulated
West,hospitalswererare,andsomalephysiciansusuallyneededpartnerstohelp
2Ibid, 162.
3Blackwell, Elizabeth. Pioneer Work in Opening the Medical Profession to Women; Autobiographical
Sketches. New York: Source Book Press, 1970. 26
4Hamilton, Alice. Exploring the Dangerous Trades; the Autobiography of Alice Hamilton, M.D. Boston:
Little, Brown and Company, 1943.
67
withtheirpractice.5Inthiscase,thepursuitofmedicinewasthefulfillmentofbotha
professionalcallingandadomesticdutytohelpthefamilyasmuchaspossible.
Wehaveseenthatwomenphysicianshadtorenegotiatenotionsof
femininityinordertoreconciletheirwomanhoodandtheirprofessionalism.While
thepursuitofmedicineconstitutedinsomewaysaradicaldeparturefromgendered
expectationsofbehavior,mostwomenphysicianscontinuedtoconformtothese
expectationstosomeextent.Manyweremarriedandoftenhadchildren.According
toCathyLucetti,almostone-thirdoffemalephysiciansweremarriedbefore1900.6
Formany,inmanyruralareasoftheAmericanWest,wherehospitalsweresparse,it
wasfairlycommonplaceforwivestogointopracticewiththeirhusbands.Still,
thereweresomethatdepartedfromsuchexpectations,likeMaryEdwardsWalker.
Walkerworetrousersandbloomers,divorcedherhusbandupondiscoveringhewas
havinganaffair,andwastheonlywomanphysiciantoworkonthebattlefieldinthe
CivilWar.ShetreatedwoundedUnionsoldiersdespitenotreceivingcompensation,
asherpresencewasnotofficiallysanctioned.Nevertheless,heraidwaswelcomed
bythesurgeonsheworkedalongside,somuchsothatheofferedtosplithisown
salarywithher.Sherefusedhisoffer,andforherworkintheCivilWar,becamethe
onlywomantobeawardedtheCongressionalMedalofHonor.7
5Luchetti, Cathy. Medicine Women: The Story of Early-American Women Doctors. New York: Crown
Publishers, 1998. 35-45
6Luchetti, Cathy. Medicine Women: The Story of Early-American Women Doctors. New York: Crown
Publishers, 1998. 83
7"Changing the Face of Medicine | Dr. Mary Edwards Walker." U.S National Library of Medicine.
Accessed April 22, 2016.
https://www.nlm.nih.gov/changingthefaceofmedicine/physicians/biography_325.html.
HerMedalofHonorwasthentakenawaybriefly,andeventuallyregainedposthumously,afterher
great-niecefoughttohaveitreturned.
68
Itisimportanttonote,however,thatsomeonelikeWalkerwouldhavebeen
deniedadmissiontotheElizabethBlackwell-runmedicalcollegeassociatedwiththe
NewYorkInfirmaryforWomenandChildrenforbeingtooradical.Blackwell’sdraw
tomedicinewasnotascientificone,butamoralone.Furthermore,shewasastrong
proponentofmaternalistmedicine,whichispredicatedonthepremisethatwomen
weremorallysuperiortomen.ThisplacedherinoppositiontowomenlikeMary
PutnamJacobi,whoseguidingprinciplescenteredaroundrationalthought,
empiricalevidence,andcontributingtothefieldofmedicinenotonlythrough
treatment,butalsothroughscientificinnovation.TheprinciplesthatJacobi
embodiedmadeheroneofthemostwellrespectedwomenphysiciansamongsther
malecolleagues.ReginaMarkellMorantz-SanchezposesBlackwellandJacobias
polaropposites.Notonlydidtheydifferintemperament,initialattractiontothe
field,andapproachestothepracticeofmedicine,theyalsodisagreedonthebroader
roleofthewomanphysician.Blackwellendorsedthepracticeofsocialmedicine,
andsawmedicineasameansofcharitableworkandreform,whereasJacobi
endorsedthepracticeofscientificmedicine,withallclaimsbackedupbyscientific
proofbeforebeingactedupon.Furthermore,Jacobithoughtthattheoveremphasis
onwomen’smoralresponsibilityandsentimentcouldhurttheircause,especially
whenitinterferedwiththeirscientificcontributions.
Whileatfirstglancebothmoralmedicineandscientificmedicinedonot
seemtobemutuallyexclusive,acloserexaminationrevealsthedifficultiesinvolved
inreconcilingbeliefinboth.Forexample,instudyingthepreventionofdisease,
Jacobistronglysupportedthestudyofbacteriology,whileBlackwellfocusedinstead
69
onsanitation.Blackwell’sreasoningforthiswasnotpremisedonthescienceof
disease,orthepresenceofmicroscopicdisease-causingorganisms,butwasinstead
focusedonmorality.Shebelievedthathealthwasthenormanddiseasewasthe
abnormalresultofimmoralbehavior,uncleanlinessbeinganexampleofsuch
behavior.Shefeltdiseasecouldbecuredorpreventedbylivingacertainway.This
ideaofhealthandlifestylecenteredonhygiene.Bacteriologyunderminedthis
ideology,byreducingtheimpactofhygieneondiseaseprevention,whichinturn
underminedtheconceptionofthemoralbasisofdisease.Blackwellopposed
bacteriologybecauseitsimplicationsopposedthemoralnatureofhealthcare,which
thensubvertedherideasregardingthemoraldutyofwomeninmedicine.If
bacteriologywerebroadlyaccepted,thendiseasewouldnothaveamoralbasisat
all.Consequently,therewouldbenoobligationtoinstructthegeneralpublicon
moralissues,suchaseducationandchildrearing.Thisdestabilizedthegrounds
uponwhichBlackwellarguesforincreasedfemaleparticipationinmedicine—their
superiormoralsensibilitiesandincreasedabilitytoadvisethepubliconmoral
issues.SobeliefinbacteriologyfundamentallysubvertedthemeansforBlackwell’s
endgoalofsocialreform.
Instead,Blackwellstronglyadvocatedforsanitation,andherInfirmarywas
oneofthefirsttohaveanM.D.servingaschairofhygiene.Appointingsomeoneas
chairofhygienewasawayofmaintainingaconstantcheckontheinherentdirtiness
ofdisease.BacteriologyemergedslightlyafterBlackwellearnedherdegree,and
seemedtoindicatethathygiene,whileanimportantfactor,wasnotinfactsufficient
inandofitselftopreventdisease.Moreimportantly,bacteriologywasalso
70
representativeofthetriumphoflaboratoryscienceovermoraltruth.Blackwell
believedthatwomenhadsuperiormoraljudgmenttomen,andbelievedintheir
maternalpower.InanaddressdeliveredattheopeningoftheLondonSchoolof
MedicineforWomen,Blackwellsaid“whateverrevoltsourmoralsenseasearnest
womenisnotinaccordancewithsteadyprogress.”Shebelievedthatthemoralityof
scientificprogressshouldbeconsideredovertheperceivedscientificbenefitsof
thatprogress.Forexample,Blackwellwasalsoopposedtovivisection,because
whileithadpositiveintentions,centeredinlearning,theseendswereobtainedby
morallyimpermissiblemeans,whichwouldcountercorrectfemininemoral
intuition.Jacobi,ontheotherhand,feltthatexperimentationandscientificevidence
weresufficienttoalterbeliefsregardingdisease,eveniftheycontradictedprevious
moraltheories.
Jacobi’sembraceofmasculine-genderedrationalthoughtandscientific
reasoning,suchasbacteriology,didnotprecludeherfromclaimingfemininity.One
ofthewaysJacobiandotherwomenphysicianspracticedfemininitywasby
engagingwithfeminineexpectationsofmarriageandmotherhood.MaryPutnam
JacobimarriedAbrahamJacobi,aprominentphysicianrenownedasthefatherof
pediatrics,whoalsoservedaspresidentoftheAmericanMedicalAssociation.8
WhileElizabethBlackwelldemonstratedalongstandingwarinessofromantic
relationships,andconsciouslychosetoavoidengaginginthem,referringtoher
careerasputtingabarrierbetweenherselfandmarriage,Jacobiwroteofbeing
8Morantz-Sanchez,ReginaMarkell.SympathyandScience:WomenPhysiciansinAmericanMedicine.
NewYork:OxfordUniversityPress,1985.180.
71
perfectlywillingtomarrysomeone,giventhattheywouldallowhertopursueher
careerinthewaythatshewanted.
JacobiandBlackwellalsohaddifferentapproachestoadvocatingforwomen
physicians.Blackwellpositedthatwomenhaduniquetalentsthatmadethemmore
suitedthanmentomedicine.Herideasofmaternalistmedicinesetwomenapart,
andideallyhadthemservingascompassionatemoralpoliceregulatingmedical
authority.Blackwell’sargumentsreliedontheinherentdifferencesbetweenmale
andfemalecharacteristics,usingasortoffemaleexceptionalisminordertoconvey
theabsoluteneedforwomeninmedicine.Jacobi,ontheotherhand,wasofthe
beliefthatmenandwomenwereequalandsimilarincapacity,andoughttoprove
thosecapabilitiesthroughscientificachievement.Shedistancedherselffrom
medicalinstitutionsrunexclusivelybywomen,refusingateachingpositionatthe
Women’sMedicalCollegeofPhiladelphia.9WhileJacobididn’tentirelydiscreditthe
advantageoffemininecharacteristicsinphysicians,shefeltthesedifferenceswere
acquiredratherthaninherent.10Regardlessofthis,shefelt,womenshouldbe
completelyintegratedintomedicineinordertoobtainequality.
Dr.SarahDolley,anearlyprofessorofobstetricsattheWomen’sMedical
CollegeofPhiladelphia,discussedhervisionofwomenasmedicine’smoral
compassesin[year]closinglectureattheWMCP:
Arewomentobeapowerforgoodinthemedicalprofession?...Withglad
thankfulnesswecansaythemostcultivatedcommunitiesnolongerregard
theentranceofwomanintotheprofessionasanimpertinence.Butareour
9Morantz-Sanchez,ReginaMarkell.SympathyandScience:WomenPhysiciansinAmericanMedicine.
NewYork:OxfordUniversityPress,1985.184.
10Ibid187.
72
responsibilitieslessenedbythisonestepinadvance?...No!...Ifyouneednot
showcausewhyyouhavegoneinthefaceofold-timeprejudices,andessay
toenteraprofessionwhichisjustlygivenhighplace,andheldinreverence
bythepeople,youmustshowaseriousnessofmoralpurpose,andmust
bringintotheMedicalProfessionthatwhichithasarighttoexpectfromyou,
amoralpowerwhich,likethe“littleleavenhidinthreemeasuresofmeal,”
shall“leaventhewholelump,”andsodoyourpart…tomaintaintheintegrity,
topreservethefacts,andprofitbythetraditionsofMedicine.11
ThiswasverymuchinlinewithBlackwell’sideaofthought—thatthepresenceof
womenintheprofession,eveniftheywerenotthemajority,wouldworktomorally
elevateandpurifytheprofessionasawhole.
Blackwellherselfcamefromafamilyofactivesocialreformers.Herfather
wasanabolitionist,andhersister-in-lawwaswomen’srightsactivistLucyStone.
ThisspiritofactivismwasastrongmotivationwhenBlackwellwasdecidingona
profession.Simplystated,Blackwellwasinterestedfirstinsocialcausessuchas
abolition,educationreform,anddressreform,andtheninmedicine,whichshesaw
notasanendinandofitself,butasameanstocontinuetoaidsocietyina
meaningfulway.Havingtheauthorityofawell-educatedphysicianallowedhera
platformfromwhichshecouldwriteandbetakenseriously.Shewrotepamphlets
onhowyounggirlsshouldbeeducated,ontheimportanceofmaintainingahygienic
environmentasrelatingtodiseaseprevention,andothersocialcauses.Her
credibilitywassolidifiedbyherprofessionalqualifications.12
11Dolley,ConcludingLecturetoWMCPgraduatingclass,1874.sentuponrequestto.
accessedAug.13,2015,attheNationalLibraryofMedicine,attheNational
InstitutesofHealth,Bethesda,MD.
12Morantz-Sanchez,ReginaMarkell.SympathyandScience:WomenPhysiciansinAmericanMedicine.
NewYork:OxfordUniversityPress,1985.190.
73
Furthermore,Blackwellusedherprofessionasawaytocutherselfofffrom
formingromanticattachments.Sheexplainedherselfinherautobiographythatshe
wasnotinfactrepulsedbymen.Rather,shefeltherselftoosusceptibletoromantic
feelings,despiteanaversiontolifelongintimacy.Inthepursuitofhergreatand
noblework,shewasabletopresentherselfwithanironcladreasonnottoengage
toostronglywithmeninaromanticfashion.Despitethisdesiretoavoidmarriage,
Blackwellwasabletousewhatsheconsideredhernaturalmaternalinstinctstotake
careofpatients.
Blackwellalsoeventuallyadoptedayounggirl,anIrishimmigrantnamed
Kitty.Inthisway,Blackwellwasabletomeetthesocialexpectationsforwomenin
termsofchildrearingandmotherhood.KittyalsoaddedvaluetoBlackwell’slife,as
Blackwellherselftoldit.Blackwellhadbeenstrugglingtoestablishherself
professionallyinNewYork,andhadbeenfeelingpessimisticandlowabouther
hopesforsuccess.ShedescribedthewayinwhichKittyinfluencedherasfollows:“I
desperatelyneededthechangeofthoughtshecompelledmetogiveher.Itwasa
darktimeandshedidmegood—hergenial,loyal,Irishtemperamentsuitedme.”13
Herchoicetoraiseanorphanedimmigrant,particularlyanIrishone,isyetafurther
extensionofherreformisttendencies.Atthistime,asimmigrationintotheUnited
Statesincreased,variousEuropeangroups,particularlytheIrishandtheGermans,
weredeeplyracialized.Bypluckingadeeplydisadvantagedchildwithnofamilyor
resourcesfromtheroughandraisingherasthedaughterofawhitemiddle-class
13Blackwell,Elizabeth.PioneerWorkinOpeningtheMedicalProfessiontoWomen;Autobiographical
Sketches.NewYork:Longmans,Green,and,1895,188.
74
femalephysician,Blackwellwasperforminganactofcharity.Insodoing,shealso
managedtoreapmoralbenefitsherself,intheformofupliftedspirits.
Still,inherrelationshipwithKittyweseetheblurrednatureofBlackwell’s
ideasconcerningmedicineandmotherhood.InsteadofcallingBlackwell“mother,”
Kittycalledher“Doctor.”Infact,asBlackwelltoldthestory,Kittywasquitetaken
abackwhenshecameacrossBlackwellconsultingwithamalecolleaguewhoshe
calleddoctor.“Afterhewasgone,shecametomewithaverypuzzledface,
exclaiming‘Doctor,howveryodditistohearamancalledDoctor!’”14That
BlackwellwouldchoosetobecalledDoctorbyheradopteddaughtermakesa
powerfulstatementabouthowshesawherself,situatingherroleasaphysicianas
theforefrontofheridentity,andmeldingthisrolewiththatofamother.This
reflectsbackonBlackwell’sconceptionoftheroleoffemalephysicians.
Furthermore,themoralpolicingroleshesoughtforherselfandhercolleagueswas
comparabletothemoralsupervisionamotherwouldgiveherchild.
InsterncontrasttoBlackwell’sinitialrevulsion,MarieZakrzewska
demonstratedaveryearlyinterestinmedicineandscience.Itisimportanttonote
thatBlackwell’sreactionwaslikelyduetosocialconstructionsofthebodyasvulgar,
andherageatthetimeshefirstconsideredmedicinemeantthatshehadbeenmore
heavilyinfluencedbythosesocialconceptions.Zakrzewska,ontheotherhand,was
introducedtomedicineasayoungchild.Whenshewasquiteyoung,shewasliving
atamidwiferyschoolwherehermotherstudied.Shehadfallenill,andhadhadto
havehereyesbandaged.Shefollowedoneofthedoctorsblindlyonhisrounds.
14Blackwell,Elizabeth.PioneerWorkinOpeningtheMedicalProfessiontoWomen;Autobiographical
Sketches.NewYork:Longmans,Green,and,1895,189.
75
Shortlyafterthebandageswereremoved,shewastoldofayoungmanwhohad
beenpoisonedandwhosebodylayinthemorgue.Shewenttoinvestigate,lookedat
thebodyatsomelength,andturnedtoleave,onlytofindthatthedoorswereall
locked.Shewasnotletoutuntilthenextday.Zakrzewskademonstratedinthis
anecdoteasortofintellectualcuriosity,whichismarkedinitslackofdisgustforthe
body’ssupposedvulgarity.15
WhileBlackwelldescribesherinitialrevulsionsinvividdetail,Zakrzewska,
youngeruponexposuretomedicine,andlessexposedtosocialnormsinanisolated
environment,exhibitedanopennesstoandhungerforlearning.Itisalsointeresting
tonotethatZakrzewskawasaPolishimmigrant,makinghersuccessinAmerica
evenmoreremarkable.16Zakrzewskacamefromafamilywithastrongbackground
ofhealthprofessionals—hermotherwasamidwifeandhergrandmothera
veterinarysurgeon.17Sheherselfwasalreadyanestablishedmidwifebeforeher
immigrationtotheUnitedStates.18ElizabethBlackwellbecameamentortoher,
encouraginghertoattendWesternReserveMedicalCollegeinClevelandand
providingfinancialandprofessionalsupportpriortoandafterhergraduation.
ZakrzewskathenworkedattheBlackwells’NewYorkInfirmaryforWomenand
ChildrenpriortohermovetoSamuelGregory’sFemaleMedicalCollegeofNew
England.19Inthisway,Zakrzewskaprovidesuswithanarrativethatverymuchruns
15OutoftheDeadHouseChapter1,anecdoteandanalysis
16WhileherfamilyhadPolishroots,ZakrzewskaherselfwasborninBerlin,and
17ChangingtheFaceofMedicineNIHNLMpage,MarieZakrzewska
18EBAutobio.
19ChangingtheFace…
76
countertothatofBlackwell,promptedbyscientificcuriosity,ratherthansocial
agenda.
BlackwellsupportedZakrzewskawhenshewasearlyinhercareer,beforeit
becameclearthattheirvisionsforwomenphysiciansweredifferent.Blackwell’s
relationshipswithmanyofherprotégéesandcolleaguesweresimilarinthisway—
sheendedupleavingtheNewYorkInfirmaryinthehandsofhersisterEmilywhen
theydifferedtoomuchintheiropinionsregardingitsmanagement.Sheand
FlorenceNightingale,renownedandwell-respectednurseduringtheCrimeanWar,
felloutoverthelocationofahospitaltheyhadplannedtogether,andBlackwell’s
positioninthathospital.ShedifferedwithElizabethGarrettAnderson,withwhom
shehelpedfoundawomen’smedicalcollegeinLondon,overitsmanagement,and
herinvolvementwasgraduallyscaledback.However,Blackwellmakesnomention
ofanyofthesedisagreementsinherautobiography.Thissuggeststhatshevery
muchvaluedtheportrayalofunityamongstwomenphysicians.Therewasenough
oppositionfromsocietyasawholeandfrommalephysiciansinparticular,that
differencesweretobediscussedprivatelyratherthanpublicly.
Whatallowedphysiciansthislevelofsocialauthority?Manyprogressive
physiciansatthistimefeltitwastheirdutynotonlytotreatpatients,buttoaddress
socialills.Theconceptofthesocialorganismwasverypopularatthistime.By
treatingthecommunityasawholeasasingleorganism,advocatesofthis
philosophywereabletojustifyhavingdifferentrolesfordifferentindividuals.This
servedastacitandsometimesovertsupportforsocietaldiscriminationand
segregationbasedonraceandgender.Howdidwomenphysiciansparticipatein
77
thistheory?Thesocialorganismtheoryheldthatpeoplewhohelddifferentsocial
positionswereequallyvitalforthehealthyfunctioningofsociety.Thisfitinvery
nicelywithwhatBlackwellandotherearlywomenphysiciansadvocated:distinct
butequalrolesformenandwomeninmedicineandinbroadersocietyasawhole.
Treatingsocialproblemsasdiseasesofthesocialorganismalsoallowedphysicians
auniquepowertoadvocatefortreatmentsorcuresofthesesocialills.
WhileBlackwellandothersfocusedtheirenergyonsocialreformrelatingto
theperceptionofgender,somenon-whitefemalephysiciansalsousedtheir
authoritytorenegotiaterace.Raceplayedamassiveroleintheavailabilityof
healthcareinthenineteenthcentury.Racistideaswerewidespreadinthisera,and
oftensupportedbybranchesofsciencesuchasphrenology.Theeffectsofingrained
racistideologyresultedinincreasedpovertyanddecreasedaccesstoeducationfor
NativeAmericansandAfricanAmericans.HistorianEdwardH.Beardsleyargues
that“intheearly1900’s[morethanfortyyearsfollowingtheCivilWarandabolition
ofslavery],theviewstillhadcurrencyamongeducatedsouthernersthatblack
women(andmen)werepsychologicallyandconstitutionallyunfitforfreedom.”20
Forblackwomen,raceplayedalargerroleindeterminingtheiraccesstohealthcare
thangenderdid,inthattheyhadmuchlessaccessthanwhitewomen,andsimilar
accesstoblackmen.Similarly,whitemedicalprofessionalsfoundthatAfrican
Americansweremorelikelytohavediseasessuchastuberculosis,gonorrhea,
syphilis,diabetesmellitus,andcancer.Ratherthanattributingthisdifferencein
20Pripas-Kapit, Sarah. "“We Have Lived on Broken Promises”: Charles A. Eastman, Susan La Flesche
Picotte, and the Politics of American Indian Assimilation during the Progressive Era." Great Plains
Quarterly 35, no. 1 (2015): 51-78. doi:10.1353/gpq.2015.0009. 51
78
frequencytolowerincome,lesseducation,increasedstress,andpoordiet,white
medicalprofessionalsattributedthemtoinherentbiologicaldifferencesbetween
whitesandblacks.
Whilemostwomenphysiciansusedtheirprofessionalauthorityto
renegotiategender,non-whitefemalephysicianswereuniquelyabletousethesame
methodologytoreframecertainassumptionsaboutrace.Forexample,SusanLa
FleschePicotte,aphysicianandmemberoftheOmahatribe,usedherauthorityto
discreditpopularconceptionsaboutNativeAmericans.Picottebeganhercareerat
theOfficeofIndianAffairs,whichworkedtopromotetheassimilationofNative
Americans.21Picotte’seducationandChristianfaithcombinedwithherOmaha
heritage,allowedhertoserveasanintermediarybetweenthetwogroups.For
example,sheoftenpublishedaboutherworkwiththeOmahapeopleinthe
ConnecticutIndianAssociation’sIndianBulletin.Thiswasmainlyreadbywhite
middle-to-upperclasswomen,andsoPicottewasabletouseherknowledgeofher
audiencetoportraytheOmahasaseagertoembraceawhitelifestyle,inorderto
elicitmoregenerousdonations.22
SarahPripas-KapitdescribesPicotte’saimtobeimpartingIndianvaluesand
mentalities.23ShegoesontocomparePicottetoCharlesEastman,amaleNative
AmericaphysicianoftheSanteeDakotatribe.Whilebothsharedsimilarstances,
includingstartsattheOfficeofIndianAffairsbeforelaterdivergingtooppose
21Ibid.
22Wells, Susan. Out of the Dead House: Nineteenth-century Women Physicians and the Writing of
Medicine. Madison: University of Wisconsin Press, 2001. 54.
23Pripas-Kapit, Sarah. "“We Have Lived on Broken Promises”: Charles A. Eastman, Susan La Flesche
Picotte, and the Politics of American Indian Assimilation during the Progressive Era." Great Plains
Quarterly 35, no. 1 (2015): 51-78. doi:10.1353/gpq.2015.0009. 52
79
assimilationpolicies.Pripas-Kapitattributesdifferencesintheirstances—Picotte
wasmorereceptivetostateinterferenceinNativeAmericans’livesthanEastman—
togenderdifferencesanddifferenttribalexperience.
Whilewomenphysicianswrotefrequentlyabouttheirprescriptionsforthe
practiceoffemininityintheprofession,theyalsooftenaddressedtheirpersonal
experiencesaswomenandhowtheyfeltabouttheprofession.Dr.AliceHamilton,
oneoftheforemosttoxicologistsoftheage,inherworkExploringtheDangerous
Trades,discussedherchoicetopursuemedicine:
Thereseemedonlyafewcareersopentous—teaching,nursing,thepractice
ofmedicine…Ichosemedicine,notbecauseIwasscientifically-minded,forI
wasdeeplyignorantofscience.IchoseitbecauseasadoctorIcouldgo
anywhereIpleased—tofarofflandsortocityslums—andbequitesurethat
Icouldbeofuseanywhere.Ishouldmeetallsortsandconditionsofmen,I
shouldnotbetieddowntoaschooloracollegeasateacheris,orhaveto
workunderasuperior,asanursemustdo.24
ThisexcerptallowsustodrawconclusionsaboutHamilton’svalues—whileshetoo,
prizedusefulnessasBlackwelldidbeforeher,shealsovaluedherownautonomy
andfreedomofmovement.WhendiscussingherschoolingatAnnArbor,shesaidit
“gavememyfirsttasteofemancipation,andIlovedit.”25Placingthatstatementin
thecontextofapost-CivilWarAmericaallowsustoseeyetanotherdimensionof
meaning.Herwordsclearlyshowthatshefeltanewfreedomfromasortofsocial
constraint.
ThefreedomHamiltonrelishedwasnotwithoutitscosts,however.Early
womenphysiciansoftenfacedostracizationfromsocietyasawhole.Elizabeth
24Hamilton, Alice. Exploring the Dangerous Trades; the Autobiography of Alice Hamilton, M.D. Boston:
Little, Brown and Company, 1943. 38.
25Hamilton, Alice. Exploring the Dangerous Trades; the Autobiography of Alice Hamilton, M.D. Boston:
Little, Brown and Company, 1943. 41
80
Blackwellwroteofthedifficultyinvolvedinfindingaplacetolivewhileshe
attendedmedicalcollege.Zakrzewskafacedthesameproblemintryingtorentan
officeinwhichtoseepatients.Itwassodifficultforher,infact,thatshewasunable
tofindanofficespaceuntilBlackwellofferedhertheparlorofherhome.TheJeering
Incident,whenfemalestudentswereharassedbymenatalecture,wasperhapsthe
mostviolentformofharassmentdocumentedagainstwomenphysicians,butitwas
farfromtheonlysuchinstance.Whilewomenphysiciansworkedtotrytonegotiate
aspaceforthemselvesasbothwomenandprofessionals,theycouldn’talways
controlhowtheywereseenbyothers.Despitetheirbestefforts,medicineremained
amale-majorityfield.However,utilizingrhetoricalskillsincombinationwith
scientificknowledge,theywereabletoassertthemselvesasequalparticipantsin
themedicalprofession.Usingfemalemedicaleducation,theywereabletogenerate
strongsupportnetworksthatmadeentryintomedicineeasierforeachsubsequent
woman.Finally,theywereabletousetheirprofessionalauthoritytoinformsocial
definitionsoffemininityandrace,powerfullyreframingthesenarratives.
81
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