The lady as physician
Doctor delivering under a sheet, for modesty’s sake
Women and the Rise of the American Medical Profession
IN THE US THE MALE TAKEOVER OF HEALING ROLES started later than in England or France, but ultimately went much further. There is probably no industrialized country with a lower percentage of women doctors than the US today: England has 24 percent; Russia has 75 percent; the US has only 7 percent. And while midwifery—female midwifery—is still a thriving occupation in Scandinavia, the United Kingdom, the Netherlands, etc., it has been virtually outlawed here since the early twentieth century. By the turn of the century, medicine here was closed to all but a tiny minority of necessarily tough and well-heeled women. What was left was nursing, and this was in no way a substitute for the autonomous roles women had enjoyed as midwives and general healers.
The question is not so much how women got “left out” of medicine and left with nursing, but how did these categories arise at all? To put it another way: How did one particular set of healers, who happened to be male, white, and middle class, manage to oust all the competing folk healers, midwives, and other practitioners who had dominated the American medical scene in the early 1800s?
The conventional answer given by medical historians is, of course, that there always was one true American medical profession—a small band of men whose scientific and moral authority flowed in an unbroken stream from Hippocrates, Galen, and the great European medical scholars. In frontier America these doctors had to combat, not only the routine problems of sickness and death, but the abuses of a host of lay practitioners—usually depicted as women, ex-slaves, Indians, and drunken patent medicine salesmen. Fortunately for the medical profession, in the late nineteenth century the American public suddenly developed a healthy respect for doctors’ scientific knowledge, outgrew its earlier faith in quacks, and granted the true medical profession a lasting monopoly of the healing arts.
But the real answer is not in this made-up drama of science versus ignorance and superstition. It’s part of the nineteenth century’s long story of class and sex struggles for power in all areas of life. When women had a place in medicine, it was in a people’s medicine. When that people’s medicine was destroyed, there was no place for women—except in the subservient role of nurses. The set of healers who became the medical profession was distinguished not so much by its associations with modern science as by its associations with the emerging American business establishment. With all due respect to Pasteur, Koch, and the other great European medical researchers of the nineteenth century, it was the Carnegies and Rockefellers who intervened to secure the final victory of the American medical profession.
The US in 1800 could hardly have been a more unpromising environment for the development of a medical profession, or any profession, for that matter. Few formally trained physicians had emigrated here from Europe. There were very few schools of medicine in America and very few institutions of higher learning altogether. The general public, fresh from a war of national liberation, was hostile to professionalism and “foreign” elitisms of any type.
In Western Europe, university-trained physicians already had a centuries’ old monopoly over the right to heal. But in America, medical practice was traditionally open to anyone who could demonstrate healing skills—regardless of formal training, race, or sex. Ann Hutchinson, the dissenting religious leader of the 1600s, was a practitioner of “general physik,” as were many other ministers and their wives. The medical historian Joseph Kett reports that “one of the most respected medical men in late eighteenth century Windsor, Connecticut, for example, was a freed Negro called ‘Dr. Primus.’ In New Jersey, medical practice, except in extraordinary cases, was mainly in the hands of women as late as 1818 . . . ”
“Regular” doctors try water treatment
Women frequently went into joint practices with their husbands: The husband handling the surgery, the wife the midwifery and gynecology, and everything else shared. Or a woman might go into practice after developing skills through caring for family members or through an apprenticeship with a relative or other established healer. For example, Harriet Hunt, one of America’s first trained female doctors, became interested in medicine during her sister’s illness, worked for a while with a husband-wife “doctor” team, then simply hung out her own shingle. (Only later did she undertake formal training.)
ENTER THE DOCTOR
In the early 1800s there was also a growing number of formally trained doctors who took great pains to distinguish themselves from the host of lay practitioners. The most important real distinction was that the formally trained, or “regular” doctors as they called themselves, were male, usually middle class, and almost always more expensive than the lay competition. The “regulars’” practices were largely confined to middle-and upper-class people who could afford the prestige of being treated by a “gentleman” of their own class. By 1800, fashion even dictated that upper- and middle-class women employ male “regular” doctors for obstetrical care—a custom which plainer people regarded as grossly indecent.
In terms of medical skills and theory, the so-called “regulars” had nothing to recommend them over the lay practitioners. Their “formal training” meant little even by European standards of the time: medical programs varied in length from a few months to two years; many medical schools had no clinical facilities; high school diplomas were not required for admission to medical schools. Not that serious academic training would have helped much anyway—there was no body of medical science to be trained in. Instead, the “regulars” were taught to treat most ills by “heroic” measures: massive bleeding, huge doses of laxatives, calomel (a laxative containing mercury) and, later, opium. (The European medical profession had little better to offer at this time either.) There is no doubt that their “cures” were often either fatal or more injurious than the original disease. In the judgment of Oliver Wendell Holmes, Sr., himself a distinguished physician, if all the medicines used by the “regular” doctors in the US were thrown into the ocean, it would be so much the better for mankind and so much the worse for the fishes.
Gynecological exam
The lay practitioners were undoubtedly safer and more effective than the “regulars.” They preferred mild herbal medications, dietary changes, and hand-holding to heroic interventions. Maybe they didn’t know any more than the “regulars,” but at least they were less likely to do the patient harm. Left alone, they might well have displaced the “regular” doctors with even middle-class consumers in time. But they didn’t know the right people. The “regulars,” with their close ties to the upper class, had legislative clout. By 1830, thirteen states had passed medical licensing laws outlawing “irregular” practice and establishing the “regulars” as the only legal healers.
It was a premature move. There was no popular support for the idea of medical professionalism, much less for the particular set of healers who claimed it. And there was no way to enforce the new laws: The trusted healers of the common people could not be just legislated out of practice. Worse still—for the “regulars”—this early grab for medical monopoly inspired mass indignation in the form of a radical, popular health movement which came close to smashing medical elitism in America once and for all.
THE POPULAR HEALTH MOVEMENT
The Popular Health Movement of the 1830s and 40s is usually dismissed in conventional medical histories as the high-tide of quackery and medical cultism. In reality it was the medical front of a general social upheaval stirred up by feminist and working class movements. Women were the backbone of the Popular Health Movement. “Ladies Physiological Societies,” the equivalent of our know-your-body courses, sprang up everywhere, bringing rapt audiences simple instruction in anatomy and personal hygiene. The emphasis was on preventive care, as opposed to the murderous “cures” practiced by the “regular” doctors. The Movement ran up the banner for frequent bathing (regarded as a vice by many “regular” doctors of t
he time), loose-fitting female clothing, whole grain cereals, temperance, and a host of other issues women could relate to. And, at about the time that Margaret Sanger’s mother was a little girl, some elements of the Movement were already pushing birth control.
The Movement was a radical assault on medical elitism, and an affirmation of the traditional people’s medicine. “Every man his own doctor,” was the slogan of one wing of the Movement, and they made it very clear that they meant every woman too. The “regular,” licensed doctors were attacked as members of the “parasitic, non-producing classes,” who survived only because of the upper-class’s “lurid taste” for calomel and bleeding. Universities (where the elite of the “regular” doctors were trained) were denounced as places where students “learn to look upon labor as servile and demeaning” and to identify with the upper class. Working-class radicals rallied to the cause, linking “King-craft, Priest-craft, Lawyer-craft and Doctor-craft” as the four great evils of the time. In New York State, the Movement was represented in the legislature by a member of the Workingman’s Party, who took every opportunity to assail the “privileged doctors.”
The “regular” doctors quickly found themselves outnumbered and cornered. From the left wing of the Popular Health Movement came a total rejection of “doctoring” as a paid occupation—much less an overpaid “profession.” From the moderate wing came a host of new medical philosophies, or sects, to compete with the “regulars” on their own terms: eclecticism, Grahamism, homeopathy, plus many minor ones. The new sects set up their own medical schools, (emphasizing preventive care and mild herbal cures), and started graduating their own doctors. In this context of medical ferment, the old “regulars” began to look like just another sect, a sect whose particular philosophy happened to learn toward calomel, bleeding, and the other standbys of “heroic” medicine. It was impossible to tell who were the “real” doctors, and by the 1840s, medical licensing laws had been repealed in almost all of the states.
The peak of the Popular Health Movement coincided with the beginnings of an organized feminist movement, and the two were so closely linked that it’s hard to tell where one began and the other left off. “This crusade for women’s health [the Popular Health Movement] was related both in cause and effect to the demand for women’s rights in general, and the health and feminist movements become indistinguishable at this point,” according to Richard Shryock, the well-known medical historian. The Health Movement was concerned with women’s rights in general, and the women’s movement was particularly concerned with health and with women’s access to medical training.
In fact, leaders of both groups used the prevailing sex stereotypes to argue that women were even better equipped to be doctors than men. “We cannot deny that women possess superior capacities for the science of medicine,” wrote Samuel Thomson, a Health Movement leader, in 1834. (However, he felt surgery and the care of males should be reserved for male practitioners.) Feminists, like Sarah Hale, went further, claiming in 1852: “Talk about this [medicine] being the appropriate sphere for man and his alone! With tenfold more plausibility and reason we say it is the appropriate sphere for woman, and hers alone.”
The new medical sects’ schools did, in fact, open their doors to women at a time when “regular” medical training was all but closed to them. For example, Harriet Hunt was denied admission to Harvard Medical College, and instead went to a sectarian school for her formal training. (Actually, the Harvard faculty had voted to admit her—along with some black male students—but the students threatened to riot if they came.) The “regular” physicians could take the credit for training Elizabeth Blackwell, America’s first female “regular,” but her alma mater (a small school in upstate New York) quickly passed a resolution barring further female students. The first generally co-ed medical school was the “irregular” Eclectic Central Medical College of New York, in Syracuse. Finally, the first two all-female medical colleges, one in Boston and one in Philadelphia, were themselves “irregular.”
Feminist researchers should really find out more about the Popular Health Movement. From the perspective of our movement today, it’s probably more relevant than the women’s suffrage struggle. To us, the most tantalizing aspects of the Movement are: (1) That it represented both class struggle and feminist struggle: Today, it’s stylish in some quarters to write off purely feminist issues as middle-class concerns. But in the Popular Health Movement we see a coming together of feminist and working-class energies. Is this because the Popular Health Movement naturally attracted dissidents of all kinds, or was there some deeper identity of purpose? (2) The Popular Health Movement was not just a movement for more and better medical care, but for a radically different kind of health care: it was a substantive challenge to the prevailing medical dogma, practice, and theory. Today we tend to confine our critiques to the organization of medical care, and assume that the scientific substratum of medicine is unassailable. We too should be developing the capability for the critical study of medical “science”—at least as it relates to women.
DOCTORS ON THE OFFENSIVE
At its height in the 1830s and 1840s, the Popular Health Movement had the “regular” doctors—the professional ancestors of today’s physicians—running scared. Later in the nineteenth century, as the grassroots energy ebbed and the Movement degenerated into a set of competing sects, the “regulars” went back on the offensive. In 1848, they pulled together their first national organization, pretentiously named the American Medical Association (AMA). County and state medical societies, many of which had practically disbanded during the height of medical anarchy in the 30s and 40s, began to reform.
Throughout the latter part of the nineteenth century, the “regulars” relentlessly attacked lay practitioners, sectarian doctors, and women practitioners in general. The attacks were linked: women practitioners could be attacked because of their sectarian leanings; sects could be attacked because of their openness to women. The arguments against women doctors ranged from paternalistic (how could a respectable woman travel at night to a medical emergence?) to the hardcore sexist. In his presidential address to the AMA in 1871, Dr. Alfred Stille, said:Certain women seek to rival men in manly sports . . . and the strongminded ape them in all things, even in dress. In doing so they may command a sort of admiration such as all monstrous productions inspire, especially when they aim towards a higher type than their own.
The virulence of the American sexist opposition to women in medicine has no parallel in Europe. This is probably because: First, fewer European women were aspiring to medical careers at this time. Second, feminist movements were nowhere as strong as in the US, and here the male doctors rightly associated the entrance of women into medicine with organized feminism. And, third, the European medical profession was already more firmly established and hence less afraid of competition.
The rare woman who did make it into a “regular” medical school faced one sexist hurdle after another. There was the continuous harassment—often lewd—by the male students. There were professors who wouldn’t discuss anatomy with a lady present. There were textbooks like a well-known 1848 obstetrical text which stated, “She [Woman] has a head almost too small for intellect but just big enough for love.” There were respectable gynecological theories of the injurious effects of intellectual activity on the female reproductive organs.
Having completed her academic work, the would-be woman doctor usually found the next steps blocked. Hospitals were usually closed to women doctors, and even if they weren’t, the internships were not open to women. If she did finally make it into practice, she found her brother “regulars” unwilling to refer patients to her and absolutely opposed to her membership in their medical societies.
And so it is all the stranger to us, and all the sadder, that what we might call the “women’s health movement” began, in the late nineteenth century, to dissociate itself from its Popular Health Movement past and to strive for respectability. Members of irregular sects were pur
ged from the faculties of the women’s medical colleges. Female medical leaders such as Elizabeth Blackwell joined male “regulars” in demanding an end to lay midwifery and “a complete medical education” for all who practiced obstetrics. All this at a time when the “regulars” still had little or no “scientific” advantage over the sect doctors or lay healers.
The explanation, we suppose, was that the women who were likely to seek formal medical training at this time were middle class. They must have found it easier to identify with the middle-class “regular” doctors than with lower-class women healers or with the sectarian medical groups (which had earlier been identified with radical movements.) The shift in allegiance was probably made all the easier by the fact that, in the cities, female lay practitioners were increasingly likely to be immigrants. (At the same time, the possibilities for a cross-class women’s movement on any issue were vanishing as working-class women went into the factories and middle-class women settled into Victorian ladyhood.) Whatever the exact explanation, the result was that middle-class women had given up the substantive attack on male medicine, and accepted the terms set by the emerging male medical profession.
Witches, Midwives, and Nurses Page 4