Medical Education for Women during the Nineteenth Century

Overview

Elizabeth Blackwell, who earned a medical degree in 1849, was a pioneer in the struggle to open the medical profession to women. Because almost all nineteenth century medical schools admitted only male students, women physicians established several separate medical schools, including the Women's Medical College of Pennsylvania, which began preparatory classes in 1848. Although most of the women's medical colleges were short-lived, their establishment was instrumental in helping women gain access to medical education and to subsequent careers in the medical profession.

Background

In 1849 Elizabeth Blackwell (1821-1910) earned a place in history when she became the first woman in the United States to earn a medical degree. Blackwell was a pioneer in the very difficult battle to open the medical profession to women. During this time period, the United States was going through great social changes. Social reformers agitated for the abolition of slavery, the rights of women, and for new approaches to health and healing. Although women had served as healers and midwives in America since the Colonial era, they had been excluded from formal medical training. The women's rights movement encouraged women to educate themselves about health and hygiene, to enter the professions, and to dispel the widespread belief that women were naturally sickly and frail.

Opposition to the dominant medical theories and practices of the nineteenth century led to the growth of alternative medical sects, such as homeopathy, hyropathy, botanical medicine, eclecticism, and osteopathy. The irregular medical sects were particularly attractive to women patients, and the irregular medical schools were more willing to accept women students.

In 1847, when Blackwell began to apply to medical schools, all the regular schools admitted only men, but a few years later the first female medical colleges were being established and a few schools had become coeducational. As early as 1842 a group of physicians in Philadelphia were considering establishing a medical school for women. Three members of the first faculty began teaching preparatory classes to women in 1848 so that they would be ready to enroll when the Female Medical College of Pennsylvania was formally chartered in 1850. Forty women applied for admission: eight planned to earn a medical diploma, while the rest expected to audit the lectures. The established medical community of Pennsylvania attempted to destroy the college by passing resolutions against the professors and the graduates of the school. The State Medical Society and several county medical societies decreed that women were unfit to study or practice medicine and that some of the professors were irregular practitioners. Despite continuing struggles for recognition, the school was forced to close during the Civil War. After the war the school reopened as the Woman's Medical College of Pennsylvania. Dr. Ann Preston, a graduate of the school and a woman's rights advocate, served as dean of the college and led the fight to gain recognition from the medical societies of Pennsylvania. The county medical societies did not rescind the old resolutions until 1874.

A questionnaire sent to 244 graduates of the school in 1881 by Dean Rachel Bodley provided valuable information about their work, financial, social, and marital status. Of the 189 women who responded, 166 were practicing medicine, usually with an emphasis on gynecology and obstetrics. Surprisingly, 150 women reported receiving "cordial social recognition," while only seven said that their reception had been negative. About one-third were members of a state, county, or local medical society. Most of the practitioners were quite successful, as measured by the average income for the group, which was about $3,000. Several women reported an annual income between $15,000 and $20,000. Many graduates had successfully combined marriage and motherhood with the practice of medicine. The success of these graduates might reflect the special nature of students who had overcome great obstacles to enter the medical profession.

Even after Blackwell had broken one barrier to opening the medical profession, women who graduated from medical schools found themselves facing additional obstacles, including exclusion from hospital training and practice. In response, Elizabeth Blackwell, along with her sister Dr. Emily Blackwell (1826-1910) and Dr. Marie Zakrzewska, who had earned medical degrees from the Cleveland Medical College, Ohio, founded the Woman's Medical College of the New York Infirmary (1868), a college that was dedicated to the highest standards. While many medical schools required only five months of instruction for two years, the Woman's Medical College established a three-and-a half-year program with a graded curriculum. Students had to pass both entrance and graduation examinations.

In 1848 a group of Boston physicians opened the New England Female Medical College. The goal of the new college was to teach medicine and midwifery (obstetrics) to women. After years of struggling to survive, the College merged with the Medical Department of Boston University, which was a homeopathic institution. Not surprisingly, Harvard had refused to absorb the New England Female Medical College. After teaching at the New England Female Medical College, Dr. Marie Zakrzewska, a strict advocate of orthodox medicine, left to establish the New England Hospital for Women and Children. The hospital served as a major training institution for women doctors and a school for nurses. Dr. Zakrzewska was especially committed to the special female character and social mission of the New England Hospital.

The Woman's Medical College of the New York Infirmary and the Woman's Medical College of Pennsylvania sent many graduates to the New England Hospital for further training. By 1895 these women were joined by a few who had studied at Ontario Medical College for Women in Toronto or the Woman's Medical College in Chicago. A very small number came from the coeducational University of Michigan. The Woman's Medical College of Pennsylvania, the Woman's Medical College in Baltimore, and the New England Hospital continued to grow in the twentieth century and provided separate medical education and training for women. The Woman's Medical College of Pennsylvania was the last surviving school of its kind, but in 1969 the school became coeducational.

Impact

By the 1860s women could earn medical degrees from at least three schools for women and from several schools that became coeducational. The number of women doctors increased substantially between 1870 and 1900, from about 500 to about 7,000. Even Harvard's medical school was affected by social reform movements and, in 1850, accepted a female and three black students. Unfortunately, a student riot in protest led the four candidates to withdraw. After this incident Harvard remained closed to women medical students until 1945.

After the Civil War medical schools proliferated, including female medical schools. About twenty such schools opened between 1850 and 1895, but most were short-lived. Nevertheless, in the 1880s even the Journal of the American Medical Association (JAMA) acknowledged that some of the women's medical colleges had prospered while maintaining high standards. A report in 1885 called attention to the high standards of the Woman's Medical College of Philadelphia, which had pioneered in offering a three-year graded curriculum and an eight-month school year. Moreover, graduates of the women's colleges did not do worse on medical examinations than graduates of men's colleges. Despite evidence that favored women's medical colleges and their graduates, the editors of JAMA continued to oppose higher education for women on the grounds that the energy women expended in pursuing professional goals would interfere with their proper reproductive functions.

By the late nineteenth century coeducation was becoming more common in higher education. This was especially true of the newer schools and state universities, especially those schools west of the Appalachians. For example, women were admitted to the medical departments of Syracuse University (1870), the University of Michigan (1871), and the University of California (1874). In the District of Columbia, both white and black women were able to earn medical degrees at Howard University. Financial problems in the 1880s forced Georgetown and George Washington universities to admit women. Once the economic crisis had been resolved, women were no longer accepted. Women graduates still faced obstacles to professional advancement: internships, residencies, clinical positions, and membership in medical societies were closed to them. In response, women doctors had to open their own dispensaries, clinics, and hospitals.

Johns Hopkins was the first elite eastern school to accept women. In 1892 the university was committed to establishing a model medical school, but it did not have sufficient funds. A group of prominent women raised $100,000 and offered the money to Johns Hopkins if women were admitted on the same basis as men. The trustees offered to open the school to women if the grant were increased to $500,000. When the women succeeded in raising the money, they insisted on raising admission standards to include a bachelor's degree, knowledge of French and German, and premedical studies. The faculty and trustees considered these criteria too demanding but reluctantly agreed. This decision had a profound impact on the future of medical education in the United States: the medical college of Johns Hopkins would serve as an ideal and a model for the nation. Generally, women welcomed the evolution of specific, even rigorous, criteria for admission to medical school. In 1896 33% of the students at Johns Hopkins Medical School were women. Women apparently thought that if formal rules were applied uniformly they would gain access to schools that had previously excluded them through informal and unwritten codes.

As more medical schools became coeducational, women greeted these changes as signs of inevitable progress and assumed that separate schools for women were no longer needed. In the 1890s women doctors were optimistic that their cause had prevailed and that women would be integrated into all medical schools. Optimism was one of the factors that led to the virtual disappearance of separate medical colleges for women. But the "Golden Age" for women doctors did not last long. As the medical marketplace became more competitive and professional societies strengthened their position, a reaction against women practitioners grew. Soon women found themselves subjected to new barriers and obstacles. Worse yet, when women's schools closed or merged with nominally coeducational schools, women faculty found themselves unemployed or given only informal positions and subjected to degrading restrictions. Many of these displaced women doctors dedicated themselves to progressive reform movements and social medicine and public health campaigns.

Educational reforms, stricter state licensing, and financial difficulties also contributed to the closing of many medical colleges at the turn of the century. Institutional backlash can be considered one of the causes of the decline in the percentage of women physicians after about 1900. Many previously coeducational schools returned to the policy of excluding women. Four percent of all medical graduates in 1905 were women, but women constituted only 2.6% of medical graduates in 1915. In 1955 less than 5% of medical graduates were women. At Johns Hopkins, the percentage of women students dropped from 33% in 1896 to 10% in 1916. Women who did get through medical school then found it virtually impossible to get into hospital internship and residency programs.

By the 1970s agitation for changing the education climate for women resulted in a heightened awareness about sex discrimination and some decrease in openly discriminatory policies. Between 1970 and 1975 the number of women in medical schools tripled. By the 1990s about 40% of medical students and 18% of practicing physicians were women.

LOIS N. MAGNER

Further Reading

Abraham, Ruth J., ed. "Send Us a Lady Physician": Women Doctors in America 1835-1920. New York: W. W. Norton & Company, 1985.

Alsop, Gulielma Fell. History of the Woman's Medical College, Philadelphia, Pennsylvania, 1850-1950. Philadelphia: Lippincott, 1950.

Blackwell, Elizabeth. Pioneer Work in Opening the Medical Profession to Women: Autobiographical Sketches by Dr. Elizabeth Blackwell. Introduction by Dr. Mary Roth Walsh. New York: Schocken, 1914. Reprint, 1977.

Blustein, Bonnie Ellen. Educating for Health and Prevention: A History of the Department of Community and Preventive Medicine of the (Woman's) Medical College of Pennsylvania. Canton, MA: Watson Publishing International, Science History Publications, 1993.

Bonner, Thomas Neville. To the Ends of the Earth: Women's Search for Education in Medicine. Cambridge, MA: Harvard University Press, 1992.

Corea, Gena. The Hidden Malpractice: How American Medicine Treats Women as Patients and Professionals. New York: William Morrow, 1977.

Drachman, Virginia G. Hospital with a Heart: Women Doctors and the Paradox of Separatism at the New England Hospital, 1862-1969. Ithaca, NY: Cornell University Press, 1984.

Furst, Lillian R., ed. Women Healers and Physicians: Climbing a Long Hill. Lexington, KY: University Press of Kentucky, 1997.

Hurd-Mead, Kate Campbell. Medical Women of America: A Short History of the Pioneer Medical Women of America and of a Few of Their Colleagues in England. New York: Froben Press, 1933.

Morantz-Sanchez, Regina Markell. Sympathy and Science: Women Physicians in American Medicine. New York: Oxford University Press, 1986.

More, Ellen Singer and Milligan, Maureen A., eds. The Empathic Practitioner: Empathy, Gender, and Medicine. New Brunswick, NJ: Rutgers University Press, 1995.

Walsh, Mary Roth. "Doctors Wanted: No Women Need Apply": Sexual Barriers in the Medical Profession, 1835-1975. New Haven, CT: Yale University Press, 1977.

ALICE HAMILTON AND HARVARD

In 1893 Alice Hamilton (1869-1970) earned her M.D. from the coeducational medical school of the University of Michigan. Influenced by her experiences at Hull House in Chicago, she applied her medical skills to helping workers in the dangerous trades through her pioneering work in industrial hygiene and industrial toxicology. She was invited to join the faculty of Harvard University as assistant professor of industrial medicine in 1919, because she was the only qualified candidate. To protect Harvard's tradition of male privilege, however, Hamilton was informed that she must never attempt to use the Harvard Club, which had no ladies' entrance at the time, or demand her quota of football tickets, nor was she to embarrass the faculty by marching in the commencement procession and sitting on the platform. Each year she received a printed invitation to the commencement, but her invitation always included the warning that "under no circumstances may a woman sit on the platform." Hamilton was the author of Industrial Poison in the United States (1925), Industrial Toxicology (1934), and the autobiography Exploring the Dangerous Trades (1943).