By mid-century the private horrors of mixed-sex medical encounters had become a public issue. Samuel Gregory, an “irregular” physician argued in 1850 that male obstetricians, by their very presence, created enough anxiety in their patients to lengthen the process of labor.56 Gregory’s book Man-midwifery Exposed and Corrected; or the Employment of Men to attend women in childbirth, shown to be a modern innovation, unnecessary, unnatural and injurious to the physical welfare of the community, and pernicious in its influence on Professional and Public Morality was a great success, and in 1852 “a few ladies of Philadelphia” organized around their belief that “the BIBLE recognizes and approves only women in the sacred office of midwife.”57 And Catherine Beecher raised the charge of seduction and sexual abuse, taking place in the practices of the most apparently benevolent, honorable, and pious doctors:
… A terrific feature of these developments has been the entire helplessness of my sex, amidst present customs and feelings, as to any redress for such wrongs, and the reckless and conscious impunity felt by the wrong-doers on this account. What can a refined, delicate, sensitive woman do when thus insulted? The dreadful fear of publicity shuts her lips and restrains every friend.… When such as these have been thus assailed, who can hope to be safe? 58
The popular magazine Godey’s Lady’s Book waged an all-out campaign for female physicians:
Talk about this being the appropriate sphere of man, and his alone! With tenfold more plausibility and reason might we say, it is the appropriate sphere of woman, and hers alone.
Female physicians will produce an era in the history of women … We would, in all deference, suggest that, first of all, there will be candor in the patient to the female physician, which could not be expected when a sense of native delicacy and modesty existed to the extent of preferring to suffer rather than divulge the symptoms.59
Given the tensions and moral compromise associated with male medical care, the mid-nineteenth-century movement of women into medical training took on the aspects of a crusade—for female health, for morality, for decency.
It was this sense of being involved in a moral crusade which accounts for the determination of our early female doctors. For example, Elizabeth Blackwell applied to over sixteen schools before she found one which would accept her, but, as she said, “The idea of winning a doctor’s degree gradually assumed the aspect of a great moral struggle, and the moral fight possessed attraction for me.”60 In the same year that Blackwell gained admission, Harriet Hunt was admitted to Harvard Medical College—only to have the decision reversed because the students threatened to riot if she came. (Harvard had admitted three black male students the year before and that, according to the white male majority, was enough!) Undaunted, Hunt went to seek a medical education at an “irregular” school.‡ Through the efforts of women like Blackwell, Hunt, Marie Zakrzewska, Lucy Sewall, Sarah Adamson, Ann Preston, Helen Morton, and Mary Putnam Jacobi—to mention only a few—there were, by 1900, approximately five thousand trained women doctors in the land,62 fifteen hundred female medical students,63 and seven medical schools exclusively for women.
Male doctors recognized that women in the profession posed a threat which was far out of proportion to their numbers. The woman patient who considered herself socially superior to female lay healers, yet was repelled by male medicine, would naturally welcome a woman professional. Faced with this threat to their practice, the male doctors responded with every argument they could think of: How could a lady who was too refined for male medical care travel at night to a medical emergency? Operate when indisposed (e.g., menstruating)? If women were too modest for mixed-sex medical care, how could they expect to survive the realities of medical training—the vulgar revelations of anatomy class, the shocking truths about human reproduction, and so on?§ (Elizabeth Blackwell admitted that she first found the idea of medical training “disgusting.”)64
The incongruity of a lady practicing medicine was a frequent inspiration to cartoonists. One in the English magazine Punch in 1872 shows a fashionable and feminine “Dr. Evangeline” looking up at the tall and manly “Mr. Sawyer” (British surgeons are not addressed as “doctor”):
Doctor Evangeline: “By the bye, Mr. Sawyer, are you engaged tomorrow afternoon? I have rather a ticklish operation to perform—an amputation, you know.”
Mr. Sawyer: “I shall be very happy to do it for you.”
Doctor Evangeline: “O, no, not that! But will you kindly come and administer the chloroform for me?”65
(The full humor is of course lost in an age which has forgotten about smelling salts, seventeen-inch waists, and graceful swoons.)
Dr. Augustus Gardner, a leading American gynecologist, summarized the paternalistic view of women’s unfitness for medicine in 1872:
More especially is medicine disgusting to women, accustomed to softnesses and the downy side of life. They are sedulously screened from the observation of the horrors and disgusts of life. Fightings, and tumults, the blood and mire, bad smells and bad words, and foul men and more intolerable women she but rarely encounters, and then, as a part of the privileges of womanhood, is permitted, and till now, compelled, to avoid them by a not, to her, disgraceful flight.66
There were contradictions in this nineteenth-century romanticist argument against women in medicine. Even the most sheltered Victorian lady—never mind the working-class mother struggling to raise her family in a one- or two-room tenement apartment—knew something of “blood and mire.” A woman necessarily encounters blood more often than a man, not counting surgeons and soldiers. Mothers know much more about mire and bad smells, even if they are cushioned by servants, than businessmen and professors. The argument against women in medicine seemed to say that even the sphere which women were expected to inhabit was too rough for them—as if menstruation, childbirth, defecation, etc., were too undignified for a lady to experience. Male doctors would have to take over the female body for women’s own protection. The vagina, which had for too long sullied “woman’s sphere,” would have to be removed to the province of medical professionalism.
Not too far under these arguments against women in medicine lay a nasty streak of misogyny. If women were inherently too delicate to desire medical training and certainly too modest to survive it, then it followed that any female who did succeed at medicine must be not a lady at all, but some kind of a freak. In his 1871 presidential address to the AMA, Dr. Alfred Stillé made this observation on the subject of women in medicine:
Certain women seek to rival men in manly sports … and the strong-minded 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 tend towards a higher type than their own.67
He left it unclear which was more repulsive: the “strong-minded,” though “monstrous” female medical aspirant, or her sisters who were content with their genetically inferior condition. An editor of the Buffalo Medical Journal took a less ambiguous stand:
If I were to plan with malicious hate the greatest curse I could conceive for women, if I would estrange them from the protection of men, and make them as far as possible loathsome and disgusting to man, I would favor the so-called reform which proposed to make doctors of them.68
The regular doctors did not rely on persuasion alone to discourage women from medical education. The would-be woman doctor faced some very solid road blocks at every step of her career. First it was difficult to gain admission to a “regular” school (the “irregular” sects, descended from the Popular Health Movement, maintained their feminist sympathies and openness to female students). Once inside, female students faced harassment from the male students ranging from “insolent and offensive language” to “missiles of paper, tinfoil [and] tobacco quids.”69 There were professors who wouldn’t discuss anatomy with a lady present and textbooks such as the 1848 obstetrics text which declared, “She [woman] has a head almost too small for intellect but just big enough for love.”70
Having completed her academic work the would-be woman doctor often 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. When 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. It was not until 1915 that the AMA itself admitted female physicians.
If the male regulars seem to have been overreacting, recall the historical circumstances. In the United States, middle-class women began to knock on the doors of the medical schools at a time when the profession, such as it was, was suffering from what its members saw as extreme overcrowding.‖ The male doctors were afraid of the competition, and given the popular mistrust of them, not without reason. Irregular physician Augusta Fairchild, M.D., boasted in the Water Cure Journal, October 1861:
Comets were once looked upon as omens of war. Female doctors may be viewed in very much the same light, for wherever they have made their appearance, a general uprising of the people to welcome them, and the most vigorous attempt of the regular masculine dignitaries of the ‘profession’ to quell the ‘insurrection’ have been the result.71
The movement of women into medical training had a whole train of unpleasant associations for the regular male physicians. Feminism, “irregular” medicine, and the populist assault on medical professionalism had all been indissolubly linked together in the decade of the Popular Health Movement. Throughout the century, botanic and eclectic schools continued to welcome women, so for that reason alone the feminine cause was always tainted with “irregularity,” or the “irregular” cause tainted with feminism, whichever way you cared to look at it.a Irregulars such as Mary Gove Nichols, Harriet Austin, M.D., Susannah W. Dodds, M.D., and others completed the association by their activity in such reform movements as temperance, sex education of the young, and, especially, dress reform. Drs. Austin and Dodds wore pants, and Mary Gove Nichols wore bloomers, about which experience she reminisced in 1853:
I acknowledge that I have been mobbed on account of my dress. Fourteen years ago several persons determined to tar and feather me if I dared to lecture in a certain small city.… Years have greatly mended the manner of the mobs, but more than one scamp has felt the weight of my husband’s cane in this city.72
Finally, the feminist/moralist argument against male doctors for female patients had exposed the doctors’ most vulnerable spot. There was simply no public confidence that doctors were “gentlemen.” A doctor complained in the Journal of the American Medical Association that:
the truth is patent that very many of its members are persons of inferior ability, questionable character and coarse and common fiber.
And in his presidential address to the American Medical Association in 1903, Dr. Billings stated his concern that commercial night schools were enabling “the clerk, the street-car conductor, the janitor and others employed during the day to earn a degree.”73 The patrician dream had been dashed against the commercial reality. Yet at the very same time, Victorian sexual anxieties made it all the more urgent that a synthesis be found. If it was almost prohibitively difficult for a lady to be examined by a gentlemanly doctor, how could she possibly put herself in the care of an ex-janitor or street-car conductor? The very words—“lady” and “gentleman”—have moral as well as class connotations, suggesting an ability to rise above sex in a way that could not be expected of the “lower” classes. If regular medicine drew too heavily from the “lower” types, it not only would lose status, it would lose business. Achievement of the patrician ideal was becoming, in the late nineteenth century, a commercial necessity.
The AMA Code of Ethics, adopted in 1847, had enjoined doctors “to unite tenderness with firmness, and condescension with authority, [so] as to inspire the minds of their patients with gratitude, respect and confidence.”74 (Emphasis in original.) But this would require more than a skillful bedside manner. The longed-for authority would have to come from somewhere. Keeping women out was a step in the right direction (in a male-dominated society, women are inherently less authoritative than men). But, by the late nineteenth century, patriarchal tradition was no longer in and of itself a firm enough basis for professional power. The average regular doctor (and there were more and more average doctors as the century wore on) may have been male, white, and Anglo-Saxon, but he was no more imposing a public figure than a druggist or real estate agent. If medicine was to become an authority in the lives of women, it would finally have to find a way to “soar above the sordid views of vulgar minds”—to float above cheap commercialism and sex itself.
* There were witch hunts in colonial New England, and the reader may be wondering whether they involved the persecution of female healers. As far as we know, the answer is no. The Salem witch trials, which occurred well after the peak of witch hunting in Europe, seem to have reflected commercial and status rivalries among the townspeople. It is interesting, though, that witchcraft entered Governor Winthrop’s charges against Anne Hutchinson, and her assistance at the birth of a deformed baby was cited as proof of God’s displeasure with her heresies.
† Labor historian Philip Foner explains this outcome in terms of the limited class the workingmen’s movement represented: they were the “old” working class who had been free artisans and journeymen, as opposed to the new industrial proletariat drawn from southern and eastern Europe. Compared to these people, the adherents of the workingmen’s movement were an elite themselves. In the decades to come, the sons of artisans would increasingly have a chance to get an education of some sort, and some would even find their way, ironically, into the expanding ranks of the regular medical profession.
‡ An extreme example, from Cuba, of female determination to practice medicine in the nineteenth century: Henrietta Faber practiced medicine in Havana for years—disguised as a man. In 1820 she made the mistake of “coming out”—to marry a man—and was sentenced at once to ten years imprisonment for having practiced medicine.61
§ This perception of the incompatibility of women and medicine survived among American gynecologists until late in the twentieth century. One who was interviewed in the January 1977 Ms. magazine explained, “You have to be kind of crazy to go into the field, because it’s a difficult, physically demanding residency. I had to be extremely obsessive-compulsive to get through it. This kind of behavior doesn’t look good on a woman. And I’m so attuned to ob/gyn as a male specialty that I find it hard to accept women in it. I just don’t see them as very feminine. I only know a couple of them who are feminine and good doctors too.”
‖ By contrast, medical historian Shryock argues, women began entering medical training in Russia at a time of physician shortage so that in the Soviet Union in the 1970s over 70 percent of physicians were female.
a Similarly, in the mid-twentieth century, the anti-Semitism of most regular medical schools forced many Jewish students into schools of osteopathy.
THREE
Science and the Ascent of the Experts
By the late nineteenth century, the solution was near at hand. According to Sir William Osler, America’s only titled physician, “the spirit of science was brooding on the waters.”1 Science was the transcendent force to which the doctors looked to lift medicine out of the mire of commercialism and gird it against its foes.
It was not only doctors who were eyeing science with professional self-interest. Science was well on its way to becoming a sacred national value, and any group which hoped to establish itself as the “experts” in a certain area would have to prove that they were rigorously scientific. Social work, before the eighteen eighties, had been a voluntary activity, left largely to the charitable impulses of upper-class women. As career-oriented, middle-class women began to enter the field, insisting that social work be regarded as a profession, more and more talk of “science” crept into the social work literature. The sentimental Lady Bountiful approach would have to make way for “scienti
fic charity” based on systematic investigation in each case and carefully calculated professional intervention. Even law, in its anxiety about professional overpopulation and public distrust, began to search for a “scientific” basis. In all areas, making something “scientific” became synonymous with reform. Between roughly 1880 and 1920 progressive Americans campaigned not only for scientific medicine, but for scientific management, scientific public administration, scientific housekeeping, scientific child raising, scientific social work. The United States was, according to The Atlantic Monthly, a “nation of science.”
The zeal to “reform” old professions and carve out new ones was coming from a specific group of people—a “new middle class,” according to some historians.2 These were the sons and daughters of the old-time gentry (small- to medium-size-business men, successful professionals, and the like) which had been on top of the social hierarchy in the early republic. But since the Civil War, rapid industrialization and the ferocious growth of monopolies had created a new polarization of American society: the “robber barons” were mowing down hundreds of small- and medium-size-business men as they built up their monopolies and cartels. Immigration was swelling the ranks of the poor. The sons of the old gentry found themselves thrust into a hostile world, often with little more collateral than their college degrees and “good breeding.” Education and background made them feel superior, but hardly secure. Above, they saw a “plutocracy” gorging itself on the wealth drained from small-business men; below, an untamed, menacing proletariat:
Two enemies, unknown before, have risen like spirits of darkness on our social and political horizon—an ignorant proletariat and a half-taught plutocracy.3
For Her Own Good: Two Centuries of the Experts Advice to Women Page 9