Medical History — Women in Medicine

Women finally were accepted as full-fledged medical practitioners in the nineteenth and twentieth centuries, but not without a struggle.

Of course women had been highly regarded as comforting healers for a long, long time; there probably were female practitioners in ancient Sumeria, Babylonia, Egypt, Greece, Rome, and in Pre-Columbian America. In the Middle Ages the chief medical activities of women were as midwives, but there were also skillful female doctors practicing secretly or openly. Many of the women in medicine were the wives or daughters of lower-order wound surgeons, and in Christian religious orders women treated the sick throughout the medieval period. Although we may observe a part played by women in medicine throughout history, we may also note that their activities often were undertaken to the accompaniment of disapproval and at times of outright antagonism from the populace—not only from male physicians.

During most of the world’s history licensure was not required, so it was principally public acceptance that would enable someone to perform medical functions regularly. When in the fourteenth century examinations began to be required for anyone to practice medicine, both sexes were theoretically equal. At the end of the fourteenth century in Germany, there were fifteen licensed female practitioners. In the fifteenth century the number had increased markedly, but only because the emperor had hired women to treat the indigent sick since male physicians were not available on the same terms. Although the advance of women into medicine was inexorable, it was slow.

In one field alone throughout history were women always accepted and even preferred: midwifery. Among the outstanding midwives to have received historical attention was Mme Boursier in seventeenth-century France, who may have been the first midwife to publish a scientific book on her specialty. For her services to Marie de Medicis (1573-1642), the second wife of Henry IV, she collected handsomely although she never received the pension the king promised. In England Elizabeth Cellier, after examining statistics on deaths after childbirth and abortion, concluded that two-thirds of the deaths were due to the midwife’s lack of knowledge. She persuaded James II to agree to a special hospital for women, but her outspoken criticisms of many people (including the king himself) landed her in the pillory and her books on the bonfire. Other volumes on training midwives continued to appear, but they were usually written by men.

Women continued to find it well-nigh impossible to be accepted for training and practice as full-fledged doctors, except perhaps in Italy where women had received medical education for centuries and had even occupied prestigious university chairs.

The career of Dr. James Barry (1797-1865), a medical officer in the British army who enjoyed a high reputation for fifty years as a skillful surgeon, may serve to reflect the prevailing attitudes. Of slight stature, squeaky voice, and beardless face, Barry evidently aroused no suspicion—possibly because of an aggressive manner and a reputation as an accurate marksman. When an autopsy revealed that Barry was a woman, the war department and the medical association were so embarrassed that the findings were, hidden and Dr. Barry was officially buried as a man.

The United States

As in Europe, American medical schools were also closed to females. In colonial days, although many women were midwives, nurses, and apothecaries, some actually practiced medicine. On the other hand, the attempt by Harriot Hunt (1805-75) to attend school lectures in Boston was thwarted even by the students themselves. When her application to Harvard Medical School was submitted by Oliver Wendell Holmes, who was then dean, the faculty agreed but the students objected. They drew up resolutions of rejection:

Resolved, that no woman of true delicacy would be willing in the presence of men to listen to the discussion of subjects that necessarily come under consideration of the students of medicine.

Resolved, that we object to having the company of any female forced upon us, who is disposed to unsex herself, and to sacrifice her modesty by appearing with men in the lecture room.

Ultimately, Mrs. Hunt was able to thread through a maze of oppositions elsewhere and obtain an M.D. degree in Syracuse as a homeopathic physician. She even became a professor of midwifery and of diseases of women and children at Rochester College. Later she emigrated to London and devoted herself to phrenology.

There were a few others, but the outstanding breakthrough for a woman was achieved by Elizabeth Blackwell (1821-1910). Summarily turned down by a number of schools, Miss Blackwell persisted until she gained admission to a small school in upstate New York, The Geneva College of Medicine—through a fluke! To show his liberalism the dean had presented the application directly to his students: should a woman be allowed to enter the classes? Having stipulated a unanimous decision, he was confident of a negative verdict. The students, thinking it a great joke, voted unanimously to admit her. The people of the town were so appalled that they snubbed Miss Blackwell throughout her stay. Although some authorities and faculty members predicted unruly incidents at the lectures, the classes were orderly and a genuine, respectful affection sprang up between the students and their female colleague. For instance, Miss Blackwell was asked to be absent when the anatomy of the male reproductive system was to be presented, and the students supported her refusal. Throughout the two years of her schooling (the standard course at the time) she conducted herself with dignity and courtesy, applying herself so diligently that she passed the qualifying examination with the highest average. In 1849, along with the other members of the graduating class, she received her M.D. degree.

Of course even with that the battle was hardly begun. Acceptance by the profession and the public was still far off When visiting London Dr. Blackwell was hailed by doctors and prominent laymen who had heard of her successful fight and was given access to lectures and hospitals. However, English women, with a few exceptions, were no closer to gaining admission to medicine than before. In Paris Dr. Blackwell found even more opposition to women; the only way open to broadening her training in France was in a school for midwives. Despite the reduced status associated with this enterprise, Dr. Blackwell persisted because of the opportunity to learn obstetrics in an institution which took care of thousands of pregnant women each year. Pursuing her duties she contracted a severe eye infection which incapacitated her for weeks and permanently damaged the eye (which had to be removed years later). The French medical hierarchy, now sympathetic and regretful, reversed its stand and gave her full permission to visit any hospital, clinic, or lecture. Similar invitations were offered when she returned again to London. There she met Florence Nightingale (1820-1910), who impressed Dr. Blackwell with her ideas and goals. Altogether she made several trips abroad but based herself in New York City, where she established a clinic that became The New York Dispensary for Poor Women and Children.

Dr. Blackwell’s sister Emily had similar difficulties, for although she was able to enter Rush Medical College in Chicago the Illinois State Medical Society prevented her from continuing. Nevertheless, she was able to finish a second year of training at The Cleveland Medical College, where she and another woman were given degrees, since not all practitioners and faculties resisted women’s participation in medicine. Sir James Simpson, for instance, the famous obstetrician in Edinburgh who introduced the use of anesthesia in childbirth, later welcomed Emily Blackwell as a student and praised her lavishly.

Marie Zakrzewska (“Dr. Zak”) (1829-1902), who came to the United States from Berlin where she had been a hospital’s chief midwife, also had to fight her way into medicine. Together with the Blackwell sisters she founded the New York Infirmary for Women and Children in 1857. This institution gave the few women who had managed to enter the profession an opportunity to obtain the additional hospital training so necessary to their attainment of practical skills.

Among others in the United States who managed to slip through the educational sieve was Mary Putnam Jacobi (1842-1906). In 1863 she became the first woman to be graduated from the New York College of Pharmacy. Even though she also received a degree from The Female Medical College of Pennsylvania (the first approved, legal medical school for women in the world) and thereafter interned at The New England Hospital for Women and Children, she, sought the prestige of a diploma from a great university. After considerable maneuvering and industrious study she achieved the near impossible, a medical degree from the highly reputed University of Paris. Back in New York City, she assisted Elizabeth Blackwell by teaching at the newly established Women’s Medical College of The New York Infirmary, remaining there for almost two decades. While attending meetings of The New York County Medical Society and The New York Pathological Society she met Dr. Abraham Jacobi, whom she married in 1873. Her subsequent activities seemed to multiply. She won Harvard’s coveted and highly competitive Boylston Medical Prize for a paper submitted anonymously. Her time was filled to overflowing by private practice, teaching at two schools (one of which was for men), writing, and with her husband establishing a pioneering pediatric clinic at The Mount Sinai Hospital.

The dogged persistence and demonstrated excellence of the pioneering women in American medicine gradually led to the opening of all medical schools to females, but it was not done without help from some men. The establishment of the first women’s medical school in 1850, The Female Medical College of Pennsylvania (later The Women’s Medical College of Pennsylvania), was due in large measure to the efforts of Quaker physicians and other medical men of Philadelphia. Since there were virtually no women doctors available, the faculty positions were filled by men. And courageous, principled men they had to be, for their unpopular participation was held in contempt by most of their colleagues and especially by the medical societies. Additional schools for women soon followed in other cities, notably Boston, New York, Baltimore, and Cleveland.

The university medical schools, however, were slow and even resistant to permitting females to enter, but by the last decade of the nineteenth century about thirty-five schools had finally withdrawn their objections. After the turn of the century, separate medical colleges for women became less necessary.

Nevertheless, the national, state, and county medical societies continued to oppose the membership of women. Some of the antagonism was due to the association of many female doctors (for lack of other opportunities) with the homeopathic and eclectic sects that were anathema to the recognized regular practitioners and teachers. However, in addition there were general prejudices against women in medicine resulting from social traditions which placed women on a separate moral plane. It was thought that medicine (especially its concern with sexual matters) was an unseemly subject for women to delve into, but it was not only in medicine that resistance was shown. In the Transactions of the American Medical Association of 1871, a noted pathologist merely echoed a view prevalent at the time:

Another disease has become epidemic. “The woman question” in relation to medicine is only one of the forms in which the pestis mulieribis vexes the world. In other shapes it attacks the bar, wriggles into the jury box, and clearly means to mount upon the bench; it strives, thus far in vain, to serve at the altar and thunder from the pulpit; it raves at political meetings, harangues in the lecture-room, infects the masses with its poison and even pierces the triple brass that surrounds the politician’s heart.

The Montgomery County Medical Society of Pennsylvania may have been the first local group to admit a woman, but it was not until well into the twentieth century that other societies followed suit. In 1915 women were given full membership in the American Medical Association, the same year the Medical Women’s National Association was formed. The American Medical Women’s Association came later.

Europe

Meanwhile a parallel course had been taken in Europe. The same England that had accepted the American Elizabeth Blackwell as a practitioner in the Official Medical Register was rigidly opposed to the training of Elizabeth Garrett (1836-1917).

Although at first not certain she aspired to a medical degree, Miss Garrett received encouragement from Elizabeth Blackwell. Entering the teaching hospital of Middlesex as a student nurse, she wheedled permission to attend lectures, charmed her way into the clinical courses, and applied herself so diligently that she received outstanding grades. On the threshold of full recognition, she was abruptly asked to leave. She tried to continue elsewhere in getting a degree, but Oxford, Cambridge, and the University of London rejected her.

She next embarked on a different course, aiming at the degree of Licentiate of the Society of Apothecaries, which would accredit her to practice medicine. She satisfied the required apprenticeship with Joshua Plaskit, her former teacher at Middlesex, but official university matriculation was also required. Since England’s universities were closed to her, she tried Scotland. Through technicalities, St. Andrews kept her out as an official candidate despite heated debate and threatened lawsuits. However, she did gain an important benefit in adding to her slowly mounting documents a certificate for a semester of private work. Rejected as well at Edinburgh, she obtained further training there by studying with the prestigious Sir James Simpson, a consistent supporter of the women’s movement.

Again back at Middlesex in London she received permission from individual practitioners to attend ward rounds. By these diligent methods she had finally by 1865 accumulated the required proofs of training demanded at her first application to the Society of Apothecaries in 1861. When the society still refused to recognize her candidacy, her father decided at whatever cost to bring suit. The apothecaries retreated and allowed her to take the examination, which she passed with ease, becoming the first woman Licentiate of the Society of Apothecaries entered on the Medical Register. Elizabeth Garrett was officially a physician.

If her odyssey had ended there, her achievement would have represented an extraordinary accomplishment. But she went much farther. She built up a large private practice and at the same time established the St. Mary’s Dispensary for Women in the slums, where she worked unstintingly. When she sought to obtain a position on the staff of a reputable hospital, she not only succeeded in convincing a reluctant board of directors but also so impressed one of its members, the wealthy ames Anderson, that he married her two years later. Not content to remain merely a licentiate she persuaded the Paris faculty, through contacts with the British ambassador, to admit her to the examination for a diploma without having to reside in Paris. She received the M.D. degree in 1870.

Thereafter her activities increased even further. She may have been the first woman to perform an oophorectomy (removal of an ovary), and in the London School of Medicine for Women she served as dean for twenty years. In keeping with the erratic course of her life, it was through an oversight that the British Medical Association—which had never admitted a woman—made her a member. In spite of outraged objections the inadvertent but legal election was not overturned, but the association took care not to open its rolls again to a woman until 1892, when general attitudes toward women in medicine were softened.

As if all this were not enough for one woman’s lifetime, after her husband’s death in 1907 Dr. Elizabeth Garrett Anderson was elected Mayor of Aldeburgh. Apparently all along the rough, winding, painful road of her career she remained poised, quiet, charming—and persistent.

Of an entirely different personality was Sophia Jex-Blake (1840-1912), a vigorous, outspoken activist who led the struggle in Britain, finally achieving the rights to medical training for herself and other women, but not without numerous frustrations and harassments. When Miss Jex-Blake and her followers found their way blocked to entering classes in the University of Edinburgh despite their official matriculation, she publicly castigated the professor of toxicology for having incited the male students to use physical force. After losing the resulting libel suit (the penalty levied was one farthing), she retaliated in 1873 by bringing legal action against the entire university to force permission for women students to enter the courses and to be examined for a medical degree. Although the case was won, a superior court overturned the decision on a close vote.

Since about the only way left to obtain a medical education was the creation of a special school, Miss Jex-Blake found cooperative physicians, especially Dr. Francis Austie, with whom she was able to found the London School of Medicine for Women (1874). But even after the women were graduated there were no reputable hospitals open to them and no official examining bodies which would certify them for licensure. The New Hospital for Women was therefore established, with vigorous support from Russell Gurney, a member of Parliament. By 1876 public opinion had altered enough to permit Parliament to pass a bill, introduced by Mr. Gurney, which gave women the right to take qualifying examinations.

When the Royal Free Hospital the next year allowed students of the London School of Medicine for Women to receive training on the wards, other hospitals and schools followed in such short order that by the end of the nineteenth century virtually all the great British universities were open to women for education and training in medicine. In Switzerland, Sweden, Denmark, Norway, Finland, Russia, Belgium, Australia, Mexico, Chile, Brazil, and other countries throughout the world, women were also admitted to medical training and practice in the last decades of the century. Holland, like Italy, apparently never restricted women from entering universities or practicing medicine, but it seems that no woman in the Netherlands availed herself of the opportunity until Aletta Jacobs (1849-1929) went through the full formal course and was licensed in 1878. Germany and Austria, among the last to liberalize their attitudes, finally also lifted restrictions at the turn of the century.

However, while women became more and more accepted in the sciences, there were still pockets of resistance. Marie Curie (1867-1934), who together with her husband had captured the attention of the scientific world and received the Nobel Prize in physics in 1903, was refused admittance into the French Academy of Sciences. Her husband Pierre (1859-1906) had also been refused about seven years earlier, but neither of the Curies had then achieved wide renown. When the Academy decided by one vote to reject Marie Curie’s application, her pioneer work had already been hailed by distinctions which included the Legion of Honor (which she turned down). The Academy’s refusal, which could only have been because of her sex, became the more ludicrous when Madame Curie was given a second Nobel Prize, now for chemistry, the first time anyone had been so honored.

Marie Curie’s achievements also demonstrated to the world that a woman could shine intellectually and perform brilliantly while fulfilling a warm, loving marriage and bringing up two children. Her notes of 1921 included a passage which revealed the remarkable character of both Curies (her husband died in 1906), who had accomplished their tasks in the face of physical hardship, callous indifference, and monetary deprivation:

A great number of my friends affirm, not without reasons, that if Pierre Curie and I had guaranteed our rights, we should have acquired the financial means necessary to the creation of a satisfactory radium institute, without encountering the obstacles which were a handicap to us, and which are still a handicap for me. Nevertheless, I am still convinced we were right.

Humanity certainly needs practical men, who get the most out of their work, and without forgetting the general good, safeguarded their own interests. But humanity also needs the dreamers, for whom the disinterested development of an enterprise is so captivating that it becomes impossible for them to devote their care to their own material profits.

Twentieth Century

Since then, so many women have entered the medical profession and made outstanding contributions that one hardly takes notice of which worker or investigator is female and which male. Maude Abbott, whose exceptional, thorough classification of congenital heart defects opened the way to the future of cardiac surgery, is remembered as a pathologist, not as a woman pathologist. Nor does one consider for long that it was a woman, Helen Taussig, who conceived the idea, which her colleague Alfred Blalock embarked upon, of surgically correcting cardiac abnormalities. Women now enter medical schools, are chosen for residency training, engage in clinical practice, hold professorships in teaching institutions, and receive grants for research on equal footing with men. In veterinary medicine women have been entering schools and practicing in ever greater percentages (in some schools comprising half the class). In Finland at least half of the dentists are female, and in the Soviet Union a high percentage of the doctors are women.

But it would be less than accurate to say that females are fully accepted in all fields of medicine. Whereas obstetrics, gynecology, and pediatrics have been the recognized concerns of women throughout the ages, the fields of surgery, orthopedics, and urology have not attracted many women, possibly as much because of a presumption of not being accepted by patients of both sexes as professional resistance. Furthermore, in most countries there are few women in high academic medical directorships except in schools for women.

In 1947, a woman first won the Nobel Prize in the category of medicine or physiology. Gerti T. Cori received this recognition together with her husband, Carl F. Cori, for proving an important concept in genetics, that an enzyme deficiency could be inborn and responsible for a disorder of metabolism. Thirty years later, 1977, Rosalyn Yalow was the second female Nobel laureate in medicine. With Solomon Berson, she developed the radioimmunoassay technique, which opened up new investigations in a variety of fields. Ironically, Dr. Yalow was steered away from graduate school, where women were infrequently admitted in the 1940s, but by getting a job as secretary in the physics department she was able to take the courses that led to her doctorate.

Today, the road is open and the future journey seems clear. The first woman to become president of a state medical society may attract attention, but before long others will follow and, like their male counterparts, hardly be noticed.

1 comment

  1. Keith Reply
    November 14, 2011 at 2:17 am

    Boring… Split it down into time peroids, might help…

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