The men were “determined to make it so unpleasant for us,” Keller recalled, “that from choice, we would not care to attend another [clinic].” She remembered being greeted by jeers, whistles, groans, and the stamping of feet, while some men actually threw stones.¹ Wood carefully preserved the Philadelphia Evening Bulletin’s detailed description of the incident:

Although such violent public displays of male opposition were not frequent occurrences in the decades after the Civil War, women physicians who experienced such unpleasantries often remembered them with bitterness.³ In spite of their discomfort, however, what is most significant about the incident in Philadelphia and those few that occurred in other cities was not the extraordinary nastiness of the male students, or even the more measured protest against female students in the form of a letter a few days later from some faculty members. On the contrary, the event’s historical importance was instead to demonstrate that in 1869, public sympathies lay, not with the male students or their recalcitrant teachers, but with the women.

The managers of the Pennsylvania Hospital, for example, refused to yield to the coarse behavior and determined that women should continue to be admitted to the Saturday morning clinics in spite of the men’s bad manners. Moreover, the Evening Bulletin, in conjunction with most of the other newspapers in the Northeast that reported the story, had nothing but contempt for the misconduct. The Philadelphia Public Ledger, for example, labeled the response “moral carditis,” arguing that “this community has been the victim of an insult which it is compelled to resent to the uttermost.” Hinting that women might indeed be the intellectual superiors of men after all, the editors denounced the male students for “seeking to triumph over struggling mind, encased though it was in a female shell.”⁴

Besides considerable public sympathy, the women students had also won a number of male physicians to their cause. Only a year after the Philadelphia incident, a prominent New York physician, Augustus K. Gardner, published an article in Leslie’s Illustrated News proclaiming himself ready to “eat my words” on the subject of women physicians. Acknowledging that twenty years before he had had some “unkind, and, I am now free to confess unjust” remarks to make about them, he wished to set the record straight. Not ashamed to admit publicly that he himself had changed both “in looks” and “in opinions,” Gardner observed that he had “lived to see women advanced.” No longer a figment of men’s imagination, women doctors were now “powers... educated, erudite, thoughtful.” What this meant to Gardner, and to other supporters like him, was that although one might still harbor notions that females were different and probably “the weaker vessel,” one would, nevertheless, be willing to give women their chance at self-improvement. “A woman who feels an irresistible impulse to study medicine,” he wrote,

Like Dr. Gardner, women who entered medicine in the midnineteenth century also believed that things had changed. “Our age is a progressive one,” explained Dr. Prudence Saur in her graduating thesis from the Woman’s Medical College of Pennsylvania. Women had a new and important role to play in the upward advance of humanity, agreed Angenette A. Hunt.⁶ Their dean, Dr. Ann Preston, who had done so much to make the study of medicine a reality for women, felt that the entrance of women into the profession marked the advance of civilization and the “fuller appreciation of the scope of Christianity.” “You feel that you have not gone out of your way to seize upon medicine as on some far off thing,” she told her students, but with significant social progress, its study “has come to you.”⁷

Women physicians’ enthusiasm reflected their confidence that they lived in the best of all possible worlds. They were convinced that women’s status had changed for the better in the nineteenth century, and that the range of female activity had dramatically broadened in their lifetime. With new conditions had come novel opportunities not available to their predecessors. So they believed, but how historically accurate was this assessment?

Until recently, most scholars would have taken issue with their rosy picture of the nineteenth-century woman’s expanded options and life-choices. Researchers, basing their conclusions on the work of Elizabeth A. Dexter, have emphasized the social confinement of Victorian women as compared with the relative flexibility of seventeenth- and eighteenth-century sex roles. They have argued that American women in the colonial and revolutionary periods had experienced a degree of autonomy and independence shared neither by their English counterparts nor their nineteenth-century descendants. They have found that even though most women in the colonies worked within their homes, and in the context of the family economy, they labored in a wide variety of occupations, sometimes exhibiting a considerable measure of status. There were female butchers, silversmiths, and upholsterers; women ran plantations, mills, shipyards, shops, and taverns. They pursued journalism, printing, teaching, tanning, and the healing arts. Most acquired their skills through apprenticeship training, often with their immediate families. ⁸

In keeping with this diverse range of female tasks, the colonies also boasted a varied group of women healers who earned part or all of their incomes from medical practice. Some were urban specialists in infant care who came to aid well-to-do mothers after childbirth, and lived six to ten weeks with a particular family before moving on. Resident nurses who were frequently consulted in folk medicine before advanced illness made it necessary to procure the aid of a physician also peopled the ranks of colonial medical practitioners. Teenaged girls, too, were sent to nurse sick relatives or attend childbeds, and many acquired significant knowledge through experience. Cotton Mather, for example, believed in woman’s natural affinity for healing and taught medicine to his own daughter.⁹ In addition, we know that women were employed as nurses in the American forces during the Revolution, and history has preserved the name of at least one woman, a Mrs. Allyn, who served as an army surgeon during King Phillip’s War.¹⁰

Women were most commonly occupied with medical practice as midwives. So formidable was the custom of using midwives in the management of childbirth in the colonies that a man, Francis Rayns, was prosecuted and fined in 1646 by a Maine court for acting as a midwife.¹¹ Colonial American women faced the perils of childbirth in the company of a community of other females who provided both companionship and medical assistance. The science of obstetrics as it is now known was still in its infancy. Midwifery in these years was a folk art that remained unquestionably women’s work.¹²

A handful of American midwives were formally trained in Europe in the seventeenth and eighteenth centuries. Many more acquired their skill by reading midwifery manuals and apprenticing themselves to more experienced women when they could. But ability varied considerably. It is likely, in fact, that Dr. Valentine Seaman was quite correct when he claimed in 1800 that the “greater part” of these women came to their calling by accident, “having first been catched ... with a woman in labour.”¹³

Still, midwives earned the respect and high regard of their communities. Indeed, of all the women who practiced healing in the colonies, skilled midwives probably enjoyed the highest status. A study of loyalist women’s property claims after the American Revolution, for example, found that at least one Charleston midwife, Janet Cumming, testified to yearly earnings of four hundred pounds sterling, an income equivalent to that of a prosperous merchant, lawyer, or government official. Earlier, in Plymouth Colony, the annals of Rehoboth record the arrival in 1663 of Samuel Fuller and his mother, he to practice medicine, she to act as midwife and “answer the town’s necessity, which was great.” The epitaph of Mrs. Wiat of Dorchester, who died in 1705, testified to her attendance at over one thousand successful births, while the Boston Weekly News-Letter in 1730 mourned the death of the “noted midwife” Mary Bradway, who lived to be one hundred years old. Numerous examples of such skilled and revered women exist in colonial records.¹⁴

The social importance of midwives and the record of female employment in other occupations prompted the notion that these years represented a “golden age” in its tolerance for a wide variation of roles for women. After the Revolution, historians have argued, women’s opportunities were gradually constricted. Women presumably lost status and eventually were displaced from professions—like medicine—where they had been active. What was described as an informal equality between men and women fostered by the preindustrial economy allegedly gave way to a rigidification of the sexual spheres culminating in the cult of domesticity and the idealistic glorification of wifehood and motherhood in the nineteenth-century.

Recent research has concentrated more closely on the social context of the greater colonial flexibility in definitions of women’s work, however. The result has been a more complex picture of social relations, intimating that earlier interpretations were too simplistic. Newer scholarship suggests, in fact, that Ann Preston and her students at the Woman’s Medical College of Pennsylvania may well have been more accurate when they claimed in the 1860s that women’s entrance into the medical profession was something wholly new in modern history.

Revisionist historians do not dispute earlier evidence that women in colonial America performed a wider range of economic tasks than their nineteenth-century descendants. Their findings suggest instead that such role flexibility should not automatically be interpreted to indicate high status for women in a particular culture, unless it holds such meaning for the participants themselves. In this regard, recent work has demonstrated that in seventeenth- and eighteenth-century America, women’s labor was so inextricably tied to household, husband, and children that no one dared challenge the assumption that their lives would be bounded primarily by the domestic circle. In colonial society both men and women knew their place; there was little need to analyze its dimensions. Hence, the historian will search in vain for lengthy treatises on masculinity and femininity, or systematic definitions of women’s roles. Such evidence usually appears when commonly held assumptions are breaking down. The absence of a public ideology about gender suggests a range of agreement so broad that the premises could be left unstated. Though a sexual division of labor existed, it was less ideologically defined than it would be in the nineteenth century and remained largely unspoken. Thus, women might perform a multiplicity of economic tasks, but the social meaning of their work would always be found in its relation to the family welfare. The variegated nature of women’s production indicated, not the extensive economic opportunity available to them, but rather the length and breadth of their economic responsibility.¹⁵

In this context, the practice of medicine by women takes on a meaning different than historians had originally thought. Let us look, for example, at childbirth. Before 1760 no other event in a woman’s life cycle exhibited greater female control or firmer female bonding. At the beginning of labor, a parturient mother “called her women together,” leaving male members of the household to wait on the periphery in anticipation. The midwife remained in control of the event, while neighbors and friends offered comfort and support. Only when women were not available did men participate in delivery, and only in difficult cases were physicians called to intervene. The experience of William Byrd of Virginia was typical. “I went to bed about 10 o’clock,” he wrote in his diary, “and left the women full of expectation with my wife.”¹⁶

A number of historians have acknowledged the central role this “social childbirth” experience played in strengthening bonds between women and enriching domestic female culture.¹⁷ Yet Laurel Thatcher Ulrich has rightly cautioned us not to interpret even premodern childbirth as an event entirely independent of male jurisdiction. In the colonies two men—the minister and the physician—might occasionally challenge female sovereignty by virtue of their status as “learned gentlemen.” In 1724, for example, the Reverend Hugh Adams of Durham, New Hampshire, was called to Exeter by a midwife attending a woman who had been in labor three and one-half days. Adams, whose scant obstetrical knowledge consisted primarily of reading a few English treatises on childbirth, claimed in his memoirs to have performed version—the complicated procedure of turning the fetus in utero—in order to deliver the child safely. The significance of such a story lies neither in this man’s pompous temerity in plunging ahead, nor even in his extraordinary luck when the infant lived. Although not common, this example of male interference still stands as a reminder of the powerful status of the “learned man” in a society where women had no learning, and the sanction such status afforded its beneficiaries to intrude if necessary at the last moment on a woman’s event.¹⁸

In a society where a woman’s destiny was to marry, have children, and direct the work of the household, the practice of medicine by women also remained linked to the private sphere. Even when they did care for the sick, they did not enjoy the same status as many of their male counterparts, but doctored primarily as skilled amateurs. Women employed as nurses in the American forces during the Revolution, for example, were rarely allowed to administer medicine and received much lower pay than male nurses or physicians.¹⁹ Even “professional” midwives functioned entirely within this context. They were primarily women who needed to contribute to the family economy, or widows without an alternative means of support, and they used traditional skills available to them according to the sexual division of labor. When they had difficulty, they were expected to appeal to physicians. Thus, women who practiced medicine in the colonies were never considered part of the medical profession, in spite of the fact that in these years American medical professionalism was itself in disarray and the medical credentials of many male practitioners left much to be desired.

Originating in the traditions of England, the medical system of the mother country reproduced itself only imperfectly in the colonies. American patterns emerged slowly out of the amalgam of English heritage and colonial experience. In the mother country, only medicine, law, and divinity were recognized as “learned professions,” and all of them required a university education. Physicians were drawn from the social elite. Gentlemen and scholars, they neither worked with their hands, as did surgeons, nor, like apothecaries, engaged in trade. These latter came from the middle classes and gained their expertise through apprenticeship. Members of an occupational group rather than learned professionals, they were denied the prestige and status of the physician. Physicians, in turn, took for granted a leadership role in social and governmental affairs.²⁰

London distinctions among physicians, surgeons, and apothecaries, however, dwindled as one moved into the countryside, and they had even less practical use in the English colonies. Few formally trained physicians emigrated, and apprenticeship soon became the chief mode of education for those laying claim to professional medical status. In America, among all the professions, specialists became generalists. Thus physicians there would perform surgery, practice dentistry, and sell drugs. It has been estimated that on the eve of the American Revolution, there were approximately thirty-five hundred medical practitioners in the colonies, and only four hundred of them had received formal training.²¹

The fluid state of colonial professionalism lasted until the middle of the eighteenth century. It meant that there was plenty of room for quacks and an occasional lady “doctress.” But the presence of women in medicine reflected primarily the shortage of healers in the seventeenth-century colonies. Even in this period lady doctors stood outside the medical profession. Whatever the reality of colonial practice, the so-called professional physician, who in England boasted of gentlemanly status and a university degree, was still by definition a man. Thus colonial licensing laws need not bother to bar women from the profession, because in the unspoken realm of social ideology a woman physician was still a contradiction in terms. Furthermore, women’s participation in general medical practice did not last long. The number of female practitioners declined early in the eighteenth century, probably because of both the increasing availability of trained men and the growth of commercial capitalism. This latter development sharply separated public and private life and created a gradual hardening of the social definitions of men’s and women’s work.

By the middle of the eighteenth century, moreover, the few hundred formally trained American physicians took steps to professionalize their ranks along European lines. After 1730 more and more young men found the means to finance medical study abroad. They returned home impressed not only by European advances in medical science, but by the self-conscious professionalism of European guilds, societies, publications, and hospitals.

Returning with prestigious foreign degrees, these doctors took the initiative in guiding subsequent institutional developments. Social and economic progress in the colonies created a provincial self-consciousness conducive to a genuine medical awakening. Opportunites for genteel practice multiplied in colonial towns and cities. In 1751 Dr. Thomas Bond and Benjamin Franklin founded the Pennsylvania Hospital, patterned on British models and the first American hospital in the modern meaning of the term. Intended to serve both poor and private patients, the new institution also offered clinical opportunities to medical students. Fourteen years later the University of Pennsylvania Medical School was established, followed by King’s College (Columbia) in 1768 and Harvard in 1780. All three institutions imitated the Continental-Scottish tradition of a university college. Though this tradition of connecting the medical school to the greater university was challenged briefly by developments in nineteenth-century medical education, it has largely reasserted itself in the twentieth century. The appearance of medical societies lending prestige to the better-qualified practitioners and pressuring provincial legislatures to pass licensing restrictions added a final touch to colonial professional developments.

It is true, of course, that the model of gentlemanly professionalism, which gained increasing acceptance in the colonies, set the tone primarily for the few hundred elite practitioners. The great bulk of the colonies’ thirty-five hundred practitioners ranged from the competently apprentice-trained to the ill-trained and even the untrained. Scattered in the towns and countryside, they provided most of the medical care. Women, when they participated in the healing arts, were found among this group as nurses, midwives, and practitioners of folk medicine. Those women in the cities who might have perhaps aspired to something more formal were denied access to a university education and relegated by social ideology more and more exclusively in these years to the home. Such developments slowly but unquestionably excluded them from legitimate practice.²²

Developments in midwifery in the larger towns and cities of England and America well illustrate this process of professionalization and exclusion. Seventeenth-century ignorance of anatomy, physiology, and surgery put physicians, surgeons, and midwives on a relatively equal plane in the management of parturition. As long as childbirth continued to be defined as a normal process, and all practitioners remained equally ignorant of the physiological mechanisms involved, custom and superstition usually barred men from the lying-in chamber, except to extricate a dead fetus. By the middle of the eighteenth century, however, improvements in the use of the forceps provided a major breakthrough in obstetrical practice and threatened the dominance of midwives, especially in slow and difficult births. Skilled mechanical interference could shorten labor and often meant life instead of death for mother and child. Gradually, with the approval of parturient women themselves and their anxious husbands, determined male accoucheurs defied custom. Among the most important of these was William Smellie, a surgeon who devoted his life to the clinical study of childbirth and became England’s leading instructor of midwifery in the eighteenth century.

Technical improvements, however, tell only half the story, for advances in anatomical research, primarily on the pregnant human uterus, also occurred. In 1774 Dr. William Hunter gave physicians their first accurate picture of the progress of the fetus through the birth canal. Taken together, the skillful use of forceps and the improved anatomical familiarity with the birth process opened the door of the lying-in chamber to the male accoucheur.²³

American expatriates in the middle of the eighteenth century often studied with the founders of the “new obstetrics.” William Shippen, Jr., and Samuel Bard, for example, both attended the lectures of William Hunter in London and apprenticed with students of Smellie. Naturally these young men became caught up in all that was fresh and innovative about English medical practice. Before long the management of childbirth among the urban middle classes on both sides of the Atlantic passed from the hands of the midwife to those of the professional physician. Although tradition, modesty and midwives themselves resoundingly denounced male midwifery, women’s fears of death or physical disability made them willing to move away from traditional birthing patterns. While most poor and rural women continued to depend on midwives, the new obstetrics gained increasing acceptance among economically advantaged men and women of influence because it stood for safety, progress, and science.²⁴

A few early male obstetricians in England and the colonies were willing to work with the midwife to allow her to retain control over “normal” cases. Indeed, William Smellie hoped to upgrade the quality of midwives’ practice by offering formal instruction to women as well as to men. Though no physician would teach a midwife to use forceps, Smellie’s writings refer with respect to skillful women, whose work he commended. Despite the fact that his own practice included some normal deliveries, he expected that the male accoucheur would attend primarily to abnormal births, where the dexterous use of instruments, a more precise knowledge of anatomy, and the techniques of version were needed.

In the colonies conservative physicians like William Shippen in Philadelphia and Samuel Bard and Valentine Seaman in New York, offered private instruction to midwives, while early in the nineteenth-century Boston physicians John Collins Warren and James Jackson hired Janet Alexander, a midwife who had trained in Scotland, to handle their normal cases.²⁵ But this professional tolerance did not last long. Most midwives could not afford to attend private classes and thus remained vulnerable to charges of ignorance. Moreover, more and more physicians believed that professional as well as scientific considerations necessitated their exclusive control over parturition. Midwifery, after all, was an excellent means for the struggling young physician to gain entree into a respectable family. Thus, after a period of intense competition between male and female practitioners, obstetricians sought to gain the upper hand.

In many respects, changes in the management of childbirth merely mirrored more profound shifts in society at large. Between 1750 and 1850, for example, the simple, undifferentiated family economy devoted primarily to subsistence agriculture began to transform itself into the increasingly intricate and complex structures of commercial capitalistic enterprise. The gradual removal of production from the household caused an elaborate shift in the economic and social meaning of women’s work.

For some women, changes in the division of labor heralded a variety of new economic options. The development of a market economy allowed the vast majority of farm women to organize at least some of their production around the demands of the market. Farmers’ wives learned to sell their surplus products—eggs, milk, or cloth—to nearby merchants for cash. In the late eighteenth and early nineteenth century they also participated in the more formalized manufacture of textiles through the putting-out system.

In cities and towns, wives and daughters participated in the budding commercial enterprises of their husbands and fathers. Some women even kept their own shops and taverns. Others profited by selling their traditional skills as nurses, teachers of young children, or midwives. Finally, women entered domestic service or filled places in New England’s nascent factory system.

Yet, however varied was women’s actual economic adjustment to these changes, as commercial capitalism gave way to industrial capitalism after 1820, the social ideology accompanying the new economic order decidedly sharpened distinctions between men’s and women’s work. Capitalism gradually drew men into an increasingly complicated economic system separated spacially as well as socially from the household. Simultaneously, it slowly reduced the time women spent in household production. As a result household labor began to take on a different character, centering more and more on strictly domestic tasks like decorating the home and caring for children. For a growing number of middle-class women this meant that consumption would replace production as an increasingly important part of their daily lives. Accompanying these economic changes was a domestic ideology that glorified the separation between the home and the world and extolled female qualities of nurturing, moral superiority, maternity, and subordination.

Political changes also seemed at first to underscore the sharpening rift between the public and private worlds. Although the republican spirit of the Revolution had a profound effect on some women’s political perceptions and self-definition, neither the War for Independence nor the new Federal Government recognized women as political beings. Indeed, their political stature relative to men actually declined in the decades after the establishment of the Constitution, as the achievement of universal white manhood suffrage highlighted as never before women’s exclusion from politics. Although they had not formally participated in political decision-making in the colonial period, networks of neighbors and kin had given them greater access to the seat of power, which was still primarily local. When the Constitution centralized the political process, making it more formal and remote, women were removed even further than they had been from the political realm.²⁷

No one described the results of these developments better than the acute French eyewitness to American life, Alexis de Tocqueville. Commenting in the 1830s that democracy had not led Americans to the erroneous doctrines prevalent in some parts of Europe that “would give to both [sexes] the same functions, impose on both the same duties, and grant them both the same rights,” he went on to explain:

Although we need not accept all Tocqueville’s observations at face value, he does suggest that the political and social changes of the late eighteenth and early nineteenth centuries threw the separation of the sexes into sharper focus. As a result, a small but significant portion of the female middle-class experienced a growing sense of confinement. By the late eighteenth century, for example, the writer Judith Sargent Murray complained that girls who were raised exclusively for matrimony were denied both a strong sense of their own identity and the personal resources to resist a bad union. To remedy the situation, Murray strongly advocated women’s education, arguing the intellectual equality of the sexes. “Should it still be vociferated,” she wrote, “ ‘Your domestick employments are sufncient’—I would calmly ask, is it reasonable, that a candidate for immortality, for the joys of heaven, an intelligent being... should at present be so degraded, as to be allowed no other ideas, than those which are suggested by the mechanism of a pudding, or the sewing of the seams of a garment?”²⁹ Others joined Murray in advocating schooling for girls, while the decline in home production created a greater willingness on the part of middle-class families to part with the labor of their daughters for the sake of education.

This movement to educate women demonstrated as no other event would that even as a new theory of womanhood arose to sequester women more securely in the private sphere, it began almost at once to be eroded by the weight of its own contradictions. The historian Linda Kerber has skillfully located the origins of the ideology of separate spheres—the nineteenth-century cult of “domesticity” —in the notion of “Republican motherhood.” At first, women’s customary absence from civic culture meant that during the intensely political time of the Revolution and after, they lacked both a vocabulary and an outlet for their patriotism. But even as political independence gave rise to structures which further banished women from the political process, it also became the catalyst for a theory of women’s roles which simultaneously worked to justify their limited participation in the public sphere.³⁰

Naturally, at a time when women’s major role in household production was being gradually supplanted by the factory, the new theory would seek as much as possible to preserve women’s integral connection with the domestic circle. If the result of such a theory was to emphasize the widening gap between public and private life, republicanism, with its passionate concern for an educated citizenry, itself intervened to bridge this growing separation. Ironically, the social theory of democracy connected the public and private in a particular way—through the politicization of women’s role in the family. Creating a civic culture that allegedly depended for its healthy existence on the virtue of its people, American democracy gave a central place to motherhood, now defined as a device to insure the perpetuation of a responsible citizenry. For the first time what women did with their children in the home had relevance for and an impact on the public process. Once women’s role as educator became politicized in such a manner, the future of women’s education was assured, though the radicalizing effects of the educative process that resulted from women’s schooling were hardly intended by many and would not be witnessed for several generations to come.

The ideology of domesticity did not merely reaffirm, it exaggerated woman’s traditional connection with the private sphere. Dictating a limited and sex-specific role for women in the home, it reflected the real subordination in marriage and in society that was still their lot in the early nineteenth century. Accompanying this shift in emphasis between 1780 and 1820 was an ideology of female prudery which has been labeled “passionlessness.” A belief in exaggerated female delicacy became decidedly more prevalent in public ideology as woman’s image shifted from that of a being innately sensual to one who was naturally moral. Disarming the older Puritan notions of female carnality, this new emphasis on woman’s intellectual and spiritual power replaced the conviction that women were the inheritors of Eve’s questionable legacy with assertions of female purity and superiority. Some women embraced the shift as a means of enhancing their status, gaining control over indiscriminate male lust in the sexual arena, and depreciating the sexual haracteristics that had served as a justification for their exclusion from public life. But eventually this change in emphasis from female physiology to female spirituality would so distort notions of female modesty that it would foster a dangerous ignorance of physiology among women.³¹ Both feminists and male physicians would question the negative aspects of this ideology of “passionlessness” once it became entrenched, but they did so in different ways and for different motives. Many women would also come to understand that in surrendering too easily to an image that defined their sex in terms of innate purity and moral righteousness they had traded one congeries of exaggerated female characteristics for another. Although the ideology of domesticity allowed them some gain in social and familial power, the concept could also be used to confine radically their circle of activity.

And yet, although the ideology of domesticity implied for social conservatives the inequality of the sexes and the subordination of women in the public realm, some women—especially educated women—took it to mean for themselves not only more power in the private realm, but a broader definition of woman’s sphere. As a consequence, the period after 1830 was a turning point in women’s public participation and social visibility. In emphasizing the socially transforming aspects of woman’s role in the home, educated middle-class women used their learning and newly acquired self-confidence to assert themselves in public. Making the home a model for social interaction, they played an unprecedented part in what eventually became the reformist critique of industrial America. The ideology of domesticity, though seemingly contradicted by the appearance of feminism, emerged historically from the same social and economic roots as women’s rights, drawing moral and ideological power from the glorification of women’s new domestic role. Indeed, it is even likely that the conservative proponents of domesticity became increasingly more shrill and demanding as they observed that many women used the cult of domesticity, not to separate themselves off from the world of men, but to participate as women in selected aspects of social and economic life. ³²

If we look again briefly at the decline in female midwifery among the middle class, we can see how these important economic, social, and ideological shifts could simultaneously limit female activity in one way while potentially expanding female opportunity in another. First came the particularization of the economy and the beginning of the professionalization of medicine in America between 1780 and 1835. These occupational changes were accompanied by the growing popularity of the ideology of separate sexual spheres. In obstetrics, because of real advances in anatomical knowledge and medical technology, what had been exclusively an event in the family guided by female custom and folk art began to move slowly toward greater professional control. The cult of domesticity kindled a greater ceremonial appreciation of women, and male obstetricians frequently argued that they were demonstrating their respect by applying their knowledge to reduce both the dangers and the pain of childbearing. Yet there were also feminist possibilities inherent in the cult of domesticity, especially the emphasis on women’s transforming power in the social realm. These possibilities inspired some women to assert their influence in matters of sickness and health in a far more comprehensive manner than they previously had—by training as professional physicians.

An apology for male midwifery published in 1820 by an anonymous Boston doctor, reputed to be John Ware, serves as a measure of just how far these complicated social and ideological shifts had progressed. Young general practitioners like Ware apparently depended on midwifery cases to win the confidence and patronage of middle-class families. Yet, in opposing female midwifery, Ware moved well beyond a defense of his pocketbook. He was also concerned to divert women’s attention from the idea of studying medicine, and, in the course of twenty-two pages, he touched on most of the arguments that would be leveled against women physicians in the decades to come.³³

Ware’s confident assertion that probably in no other city in America were midwifery cases “so entirely confined to male practitioners” unwittingly reveals that in many parts of the country the “new obstetrics” would not so quickly eradicate deep-seated, cultural objections to men in the lying-in room. For almost a century, the enemies of male midwifery had argued that the practice threatened the moral fabric of society by compromising female modesty. The transition from the midwife to the male accoucheur was not accomplished without severe protest, not just from midwives themselves, but from social conservatives who saw it as an outrage to female modesty. From the end of the eighteenth century on, both English and American critics railed against the moral depravity of the new obstetrics. Doctors were accused of taking advantage of innocent female patients. Horror stories about modest women who were so shocked by the presence of a strange man in the bedchamber that they ceased to labor appeared repeatedly in opposition literature ³⁴

As the belief in female “passionlessness” gained ground in the nineteenth century, it often turned the virtues of innocence and purity into the less desirable traits of ignorance and prudery. Victorian delicacy threatened to make it difficult for physicians to treat their women patients at all. Doctors themselves often found it hard to balance the competing claims of professionalism and delicacy. Many of them, like Charles Meigs, Professor of Obstetrics and Diseases of Women and Children at Jefferson Medical College in Philadelphia, shared an exaggerated conception of womanhood. Although Meigs worried constantly that female delicacy often prevented doctors from giving their women patients adequate treatment, his remarkable ambivalence became apparent when he observed in 1848 that,

Meigs’s private conflict between professional concerns and emerging cultural norms was common. In the nineteenth century, portions of the medical establishment accepted the idea of female “passionlessness” so thoroughly that they moved the grounds for its conceptual defense from religion to science. Only when the role of doctors in this transformation is thoroughly noted can the import of Meigs’s observations be fully understood.³⁶

Of course, not all physicians and not all women found comfort in Meigs’s remarks. In 1817 Dr. Thomas Ewell had proposed that the American government sponsor schools of midwifery modeled after those in Europe.³⁷ His reasons stemmed from his belief that male doctors treating parturient women engendered social depravity. Like William Shippen, Jr., and Samuel Bard before him, he hoped to upgrade the quality of midwifery practice in normal cases, while retaining for the physician control of difficult and dangerous deliveries. Although his program met with scant success, a generation later in 1848, Samuel Gregory, a lay health reformer, repeated Ewell’s arguments with considerably more practical results. Paradoxically, feminists by this time had begun to understand the inherently confining aspects of the idea of female “passionlessness” and modesty. Seeking to expand women’s control in health matters they joined Gregory in an uneasy alliance to establish a medical school for women in Boston. ³⁸

John Ware was quite willing to appreciate in passing the fact that women exhibited noble qualities of delicacy and spirituality. Indeed, in the best of all possible worlds, he admitted that “the circumstances, which would render females agreeable and most desirable as attendants ... are obvious.” But for him, as for most of his colleagues, the choice was one of delicacy of feeling versus safety, with “safety ... the first circumstance to be regarded.”³⁹

In order to defend professional physicians’ claims to providing greater safety for women, Ware next attempted to discredit the older notion of childbirth as a natural or “mechanical” event. Childbirth was complicated, he warned, and “no one can thoroughly understand the nature and treatment of labour, who does not understand thoroughly the profession of medicine as a whole.” Of course, this excluded midwives. Ware cautioned that midwives, ignorant as they were of general physiology, could not even detect, much less cope with, placenta previa, shock, convulsions, or puerperal fever. “Mere manual adroitness,” according to him, was hopelessly inadequate. Thus, for Ware the choice clearly lay “between the true and legitimate practitioners of the professions, and ignorant and assuming pretenders.”⁴⁰

The presence of male physicians in the lying-in chamber initiated a significant transformation in the social and scientific definition of childbirth. Over the next century and a half, parturition evolved from an event in the female life cycle that was managed by a community of women to a more private experience confined to the immediate family and shared almost exclusively by a woman and her doctor. In time childbirth gradually ceased to be viewed as natural and increasingly became defined by doctors as a disease. Moreover, the medicalization of parturition in the nineteenth century set the stage for its transferal in the twentieth century from the privacy of the home to impersonality of the hospital. At first the shift remained confined to middle- and upper-class Americans, but today the change has become universal. One reason for the transition was surely a new social appreciation of women and a desire to minimize the risks of childbirth. But the new obstetrics was also tied to the determined efforts of physicians to professionalize, and as such signaled the diminution and disparagement of laywomen’s participation in this area of medical practice.²⁶

But why not teach women medicine? With the growing popularity of female education, Ware could not successfully ignore this possibility, and so he moved to the second part of his argument. Reflecting on the nineteenth century’s new respect for woman’s intellect, Ware was quick to deny “any intellectual inferiority or incompetence in the sex.” He admitted quite simply that his objections to women becoming doctors were “founded rather upon the nature of their moral qualities, than of the powers of their minds, and upon those very qualities, which render them, in their appropriate sphere, the pride, the ornament, and the blessing of mankind.”⁴¹

According to the Victorian stereotype, women were distinguished from men by their inability to restrain their “natural tendency to sympathy” as men could and as physicians must. “The profession of medicine,” Ware observed, “does not afford a field for the display and indulgence of those finer feelings.” It was “obvious” to him that “we cannot instruct women as we do men in the science of medicine; we cannot carry them into the dissecting room and the hospital.” He admitted that medical training required men to subdue many of their “more delicate feelings” and their capacity for “refined sensibility” but went on to say that “in females” such sensibilities would be destroyed. He concluded by stating that “a female could scarce pass through the course of education requisite to prepare her, as she ought to be prepared, for the practice of midwifery, without destroying those moral qualities of character, which are essential to the office.”⁴²

Ware’s elaborate protestations well demonstrate the limitations of the ideology of female moral superiority in effecting female emancipation. Too great an emphasis on female moral purity gave credence to the formulation of an idea of separate spheres which encouraged men like Ware to use Victorian sexual stereotyping to keep women out of medicine, as well as out of other public or professional activities for which they might find themselves distinctly suited.

Ironically, the emergence of Victorian prudery encouraged some social conservatives, such as the health reformer Samuel Gregory, to support the movement to train women in medicine. More important, however, were the socially transforming elements in the cult of domesticity that inspired many middle-class women to take control of their own health and the health of their families. The result was the emergence of a popular health movement with feminist overtones which in time would help to sanction a new role for women as medical professionals. Little did John Ware dream, when he published his pamphlet in 1820, that fifty years later Dean Ann Preston of the Woman’s Medical College of Pennsylvania would receive both public and professional approval when she brought her students to attend the surgical clinics at one of the oldest and most prestigious hospitals in America.