Steven Smith, then a bright young member of the class and later a prominent New York physician and public-health advocate, witnessed the ensuing events. Over half a century later at a memorial service for his longtime friend and colleague, Elizabeth Blackwell, he recalled:

Blackwell studied medicine for two full terms at Geneva, but in an insulting footnote to the story, the school closed its doors to women soon after she received her degree. Such was the inauspicious start of the formal movement to train women as physicians.

Undaunted, women continued to seek medical training. Within two years three more graduated from the eclectic Central Medical College in Syracuse, the first coeducational medical school in the country. In Philadelphia a group of Quakers led by Dr. Joseph Longshore pledged themselves to teach women medicine and established the Woman’s (originally Female) Medical College of Pennsylvania in 1850. The following year eight women were graduated in the first class. A Boston school, founded originally by Samuel Gregory in 1848 to train women as midwives, gained a Massachusetts charter in 1856 as the New England Female Medical College. Here Marie Zakrzewska, former medical associate of Elizabeth Blackwell, early female graduate of the Cleveland Medical College, and the influential founder of the New England Hospital for Women and Children, came to teach in 1859.

Meanwhile, in New York the Homeopathic New York Medical College for Women, established in 1863 by still another early graduate, Clemence Lozier, enjoyed such success that by the end of the decade it had matriculated approximately one hundred women. Five years later Elizabeth Blackwell, now joined in practice by her sister Emily, also a doctor, opened the Women’s Medical College of the New York Infirmary.

Armed with the conviction that medical science needed a woman’s influence, hundreds of women received medical training in the decades following Elizabeth Blackwell’s graduation from Geneva Medical College.² By 1880 a handful of medical schools accepted women on a regular basis. But female pioneers, still dissatisfied with what they believed to be the slow progress of medical coeducation, founded five “regular” and several sectarian women’s medical colleges. They built dispensaries and hospitals to provide clinical training for female graduates. By the end of the nineteenth century, female physicians numbered between 4 and 5 percent of the profession, a figure that remained relatively stable until the 1960s.³

The movement to teach women medicine developed logically from the denigration of regular heroic practice, the structural growing pains of a profession in transition, and the appearance of the popular health crusade which gave women a central role in health matters. In addition, as we have seen, the changes in the organization of family life provided middle-class women with education, while their declining role in productive labor allowed them to search for new ways of performing traditional tasks. The feminist movement contributed the belief in the centrality of scientific hygiene to female emancipation and an evolving notion of woman’s right to participate in the public world beyond the home.

Women entered the profession as part of a broad effort toward self-determination in which all reformist women, from conservative social feminists to radical suffrage advocates, played varying parts. Like these, women doctors sought to redefine womanhood to fit better the demands of an industrializing society. Medicine, indeed, attracted more women votaries in the nineteenth century than any other profession except teaching, and female physicians took seriously their role in health education.

Although they remained a small minority of the profession, women doctors were conspicuous because they violated nineteenth-century norms for female behavior in a way that teachers did not. No wonder they became the focus of a debate over women’s proper role in and relationship to public and private health. Whereas amateur instructors of physiology could be dismissed as objects of public ridicule, professionally trained women physicians were another matter entirely. By the end of the 1860s, protest against them mounted from within the profession, requiring them to refine and elaborate an ideological defense of their cause.

One can see from examining their arguments that women physicians were at once ideological innovators and conservators of the past. They shared this role with other women of their era who sought an expansion of female activity, and their ideas fell well within the mainstream of feminist thinking. They used these ideas to give each other encouragement and support and to convince others to enlist themselves in the cause. The process of developing an ideology itself exerted a powerful influence on their perception of reality, shaping it and giving it meaning within the context of nineteenth-century values. We shall see that, although their reasoning was often brilliant and effective, and their practical work important, their arguments remained almost always some variation on the theme of domesticity. Indeed, they as well as their opponents depended on the tenets of the cult of domesticity to buttress their case. Though such a justification for female public activity would later prove self-limiting, this was neither true nor apparent in the nineteenth century, when only a handful of women physicians understood the dangers that lurked for them in this line of reasoning, dangers which would by the turn of the twentieth century hamper their progress within the profession.

The opponents of medical education for women, of course, were not interested in the socially transforming aspect of the new reverence for the female character. Placing women on a pedestal located firmly within the confines of the home, they justified an emotional preference for sequestered women by making them the moral guardians of society and the repositories of virtue. Fearing that women who sought professional training would avoid their child-rearing responsibilities, they reminded their colleagues in overworked metaphors that “the hand that rocks the cradle rules the world.” Woman, argued a spokesman, held “to her bosom the embryo race, the pledge of mutual love.” Her mission was not the pursuit of science, but “to rear the offspring and ever fan the flame of piety, patriotism and love upon the sacred altar of her home.”⁴

Rational legitimation of the female role often veiled less rational preferences: the home represented for nineteenth-century Americans a refuge from an immoral and often brutalizing world. A woman who dared to move beyond her sphere was “a monstrosity,” an “intellectual and moral hermaphrodite.” Nevertheless, insisted Dr. Paul de Lacy Baker, women controlled society, government, and civilization through the “home influence.” Home was

While revering the purity and repose of the home, doctors, like other Victorians, feared the animal in man and dwelt on the significance of female moral superiority in curbing man’s most brutal instincts. Woman’s venturing out into the world boded ill for civilization, for women kept men respectable. In imitating men, they ran the risk of demoralizing both sexes. Men, confessed Dr. J. S. Weatherly to his colleagues, were “little less than brutes,” and “where men are bestialized, women suffer untold wrongs.” Woman’s great strength and safety, he concluded, was in the institution of marriage, and “everything she does to lessen men’s respect and love for her, weakens it, and makes her rights more precarious; for without the home influence which marriage brings, men will become selfish and brutal; and then away go women’s rights.”⁶

Conservatives also worried that teaching women the mysteries of the human body would affront female modesty. “Improper exposures” would destroy the delicacy and refinement that constituted women’s primary charms. John Ware’s conviction that medical education with its “ghastly” rituals and “blood and agony” in the dissecting room would harden women’s hearts and leave them bereft of softness and empathy reappeared in elaborate guise.⁷

Despite the popularity of this defense of female delicacy, conservatives compromised their case when they readily admitted that women’s special sympathy made them excellent nurses. Praising Florence Nightingale’s achievements in the Crimea, they credited her work primarily to her ignorance of scientific medicine. Medical education, they argued, would surely have hardened her heart, leaving her bereft of softness and empathy.⁸

Supporters of female education quickly discovered that respect for feminine delicacy could work in their favor. Was the mother who nursed her family at the bedside ever shielded from the indelicacies of the human body? they asked. If the issue was female modesty, then why should men——even medical men—ever be allowed to treat women? As the use of pelvic examinations became part of ordinary practice, male physicians posed a greater threat to feminine delicacy than women practitioners. Indeed, the doctrine of “passionlessness” gave rise to such elaborate exaggerations of womanly delicacy that some social conservatives and some feminists alike viewed the training of women physicians as a necessary solution to the problems arising from female reluctance to disclose symptoms to male practitioners. Elizabeth Blackwell, for example, admitted in her autobiography that her first encounter with the idea of studying medicine arose from the agonized suggestion of a friend, dying of what was probably uterine cancer, that her sufferings would have been considerably alleviated had she been “treated by a lady doctor.” ⁹ Although many feminists remained ambivalent about the practical value of extreme modesty to women doctors or to women themselves, Blackwell always used the concern about the potential compromise of female delicacy generated by male treatment as an argument in favor of training women in medicine.¹⁰ It was in response to such a point of view that Boston feminists joined with the health reformer Samuel Gregory in 1848 to establish a school of midwifery that would be incorporated in 1856 as the New England Female Medical College.

But male physicians alleged other unsuitable character traits against women besides their innocence. Many agreed that Nature had limited the capacity of women’s intellect. Women were impulsive and irrational, unable to do mathematics, and deficient in judgment and courage. Their passivity of mind and weakness of body left them powerless to practice surgery. And if these disadvantages were not enough, there remained the enigmatic side of the female temperament. Dependent, “nervous,” and “excitable,” women, “as all medical men know,” were subject to uncontrollable hysteria. “Hysteria,” regretted J. S. Weatherly, M.D., “is second Nature to them.”¹¹

Even more subtle and insidious was the fear that the influx of women would alter the image of the profession by feminizing it in unacceptable ways. “The primary requisite of a good surgeon,” insisted Edmund Andrews, “is to be a man,—a man of courage.” Few physicians were prepared to surrender their masculinity gracefully, especially when technical developments like the discovery of anesthesia actually were rendering harsher images of the doctor obsolete. One Boston doctor taunted women physicians with the remark, “If they cannot stride a mustang or mend bullet holes, so much the better for an enterprizing and skillful practitioner of the stern sex.”¹²

The editor of the Boston Medical and Surgical Journal continually grumbled about women becoming an economic threat in a profession already burdened with an oversupply of practitioners. When the graduates of the orthodox female medical colleges sought admission to local and national medical societies in the 1870s, they were rejected on the grounds that their training was either irregular or of poor quality. Opponents held women’s allegedly inferior schooling against them, yet denied them access to the type of education that was acceptable and often refused to consult with them or ostracized those male practitioners who did. These insults were perpetrated despite the fact that a fair number of medical women received excellent training in the nineteenth century. As we shall see in the next chapter, a comparative study of curricula and clinical offerings in several nineteenth-century medical schools revealed that those women who earned their diplomas at the orthodox women’s colleges endured a vigorous, demanding, and refreshingly progressive course of study. Other women, self-conscious about their inadequacies and determined to procure proper preparation, sought postgraduate instruction in Europe.¹³ Complaints about inferior education and economic competition arose out of disgust with the multiplication of proprietary schools in the 1830s and 1840s which sharply increased the number of practitioners. But what remains most striking about such objections is that they took for granted women’s success in practicing medicine, as well as their ready acceptance by the public.¹⁴ Indeed, there was a desperation about this rhetoric that suggests that complaints about the entrance of women into the medical profession reflected, not the hardening of social lines between men and women, but the increasing permeability of those social boundaries.

The majority of women physicians’ professional opponents were, therefore, neither scientific nor consistent. They praised women’s abilities to nurse, but rejected their competence in medicine; they offered their arguments for female inferiority, vulnerability, and dependence alongside claims for women’s moral superiority and domestic power. But it was the group of physicians who managed to cloak their prejudices in the guise of science that proved the most injurious to women’s free development. In the 1870s and 1880s these physicians transferred the grounds for the argument over “female nature” from the spiritual to the somatic.

Rallying around a book entitled Sex in Education: A Fair Chance for Girls, published in 1873 by the Harvard professor Dr. E. H. Clarke, they based their case against women almost entirely on biological factors. Menstruation was depicted as mysteriously debilitating and higher education in any subject, as sapping the energy needed for the normal development of the reproductive organs. The results, lamented Clarke with total seriousness, were “those grievous maladies which torture a woman’s earthly existence: leuchorrhoea, amenorrhea, dysmenorrhea, chronic and acute ovaritis, prolapsus uteri, hysteria, neuralgia, and the like.”¹⁵ He concluded that higher education for women produced “monstrous brains and puny bodies; abnormally active cerebration and abnormally weak digestion ; flowing thought and constipated bowels.”¹⁶

When they chose to emphasize the devitalizing and still-ambiguous effects of menstruation, traditionalists were indeed effective. Physicians knew little about the influence of women’s periodicity, and the culture treated menstruation as a disease.¹⁷ Reasoning that only rest could help women counteract the weakness resulting from the loss of blood, complete bedrest was commonly prescribed. Thus even if opponents appeared willing to concede women’s intellectual equality—and many were prepared to do so—women’s biological disabilities seemed insurmountable.¹⁸ Since menstruation incapacitated women for a week out of every month, could they ever be depended on in medical emergencies?

The biological argument proved particularly vexing to feminists. As M. Carey Thomas, the indomitable president of Bryn Mawr and a fierce supporter of women physicians, recalled years later, “We did not know when we began whether women’s health could stand the strain of education. We were haunted in those days, by the clanging chains of that gloomy little specter, Dr. Edward H. Clarke’s Sex in Education.”¹⁹

Female physicians helped to dispel doubts about the effects of menstruation by functioning skillfully in their own professional lives. Many joined with the feminist community to launch a full-scale counterattack against the Clarke thesis. Outraged by the influence of Clarke’s book, a group of women in Boston cast about for a woman doctor with the proper credentials to call its thesis into question. In 1874 they gained the opportunity for a public forum when Harvard Medical School announced that the topic for its celebrated Boylston Essay would be the effects of menstruation on women. Writing to Dr. Mary Putnam Jacobi in the fall of that year, C. Alice Baker urged her to take up the “good work,” and “win credit for all women, while winning for yourself the Boylston Medical Prize for 1876.” Jacobi met the challenge. Because the essays were submitted anonymously, the judges did not know that the author was female. Her essay “The Question of Rest for Women During Menstruation” won the prize, to the opposition’s chagrin. The study challenged conservative medical opinion on the subject with sophisticated statistical analyses and case studies, concluding that there was “nothing in the nature of menstruation to imply the necessity, or even the desirability, of rest for women whose nutrition is really normal.”²⁰

In 1881 Emily and Augusta Pope, graduates of the New England Female Medical College, and Emma Call, an early alumna of the University of Michigan Medical School, published a survey of women physicians sponsored by the American Social Science Association. While serving as staff physicians at the New England Hospital for Women and Children, they summarized the results of their findings on the health of 430 women doctors and concluded that “some unnecessary anxiety has been wasted on this point.” They went on to say, “We do not think it would be easy to find a better record of health among an equal number of women, taken at random, from all over the country.”²¹ Similarly, women physicians who held resident positions at the various women’s colleges painstakingly monitored the physiological effects of higher education on their charges. Several of these women published studies that added to the growing body of scientific literature seriously questioning Clarke’s thesis. Indeed, one of the important contributions women physicians made to the feminist movement in the late nineteenth century arose from their willingness to challenge on scientific and empirical grounds the somatic definition of woman’s nature and to push toward innovative and less biologically constricting approaches to female health and hygiene.²²

To those Social Darwinists who used the Clarke thesis to raise the spector of race suicide by arguing that sickly women would give birth, if they did so at all, to sickly children, women physicians and their supporters responded with optimistic eugenic reasoning. They depicted themselves as living examples of the transition to higher life forms. They joined with their critics in denouncing the frivolity of the leisured woman, “crushed beneath the despotic power of relentless Fashion.” Warning that increased leisure accruing from technological advances demanded that women be given noble work to do, they urged society to check the notorious aimlessness of the civilized woman’s life. Women’s boredom was notorious: “For one case of breakdown from overwork among women,” quipped Dr. Ruffin Coleman, “there are a score from ennui and sheer inanition from doing nothing.” Professional careers, they contended, might prove essential to prevent the deterioration of women.²³

Along with most American scientists of the period, physicians accepted the neo-Lamarckian concept of the inheritance of acquired characteristics. Women doctors drew the logical object lesson : if mental as well as physical haracteristics were inherited, the race would steadily improve, but only if women could uplift themselves. Their arguments remained a warning as well as a prophecy: Hold back your women—your mothers—and you retard the race. ²⁴

Much like their opponents, female physicians took seriously the idea of their own moral superiority as women and their abilities as natural healers. They rarely quarreled directly with the concept of separate spheres, although their interpretation of this concept was quite different from that of the conservatives. Like other social feminists, women physicians defined “woman’s sphere” as broadly as possible and connected it quite directly with the surveillance of and participation in public life. Examining the ethical implications of the scientific method for medicine and society, women physicians claimed for themselves the task of integrating Science and Morality. In a letter to Dr. Harriot Hunt in 1855, Sarah Grimké expressed to her friend her own conviction that medical study held important rewards for women and for society:

A glance at the titles of the popular health manuals of the period reveals the pervasiveness of the concept of Woman as Natural Healer. ²⁶ Supporters of women physicians elaborated on such cultural assumptions to buttress their argument. “Is not Woman man’s Superior?” asked Dr. J. P. Chesney of Missouri. “It is an idea extremely paradoxical,” he continued, “to suppose that woman, the fairest and best of God’s handiwork, and practical medicine, a calling little less sacred than the holy ministry itself, should, when united, become a loathsome abomination ... from which virtue must stand widely aloof.” Women needed the tools of modern medicine. Women would attend in the sickroom, and instinct and sympathy were increasingly insufficient to fit them for this role. Women’s “affections need truths to guide them,” Harriot Hunt explained to a receptive audience at the Worcester Women’s Rights Convention in 1850. “It has begun to occur to people,” agreed Dr. Emmeline Cleveland of the Woman’s Medical College of Pennsylvania in 1859, “that perhaps the fullest performance of her own home duties” required of woman “a more extended and systematic education ... especially in those departments of science and literature which have practical bearing upon the lives and health of the community.”²⁷

Like their opponents, supporters constantly connected womanhood with the guardianship of home and children. Women were morally superior to men, claimed Elizabeth Blackwell, because of the “spiritual power of maternity.” The true physician, male or female, she argued, “must possess the essential qualities of maternity.” For Sarah Grimké, this quality was a “love spirit.” Like Blackwell, she deplored for women the study of science for its own sake. No woman could be called a physician who could not minister to the spirit as well as to the body, and she confessed that her deepest fear was the proliferation of women doctors “unblest with this gift and whose highest attainment is a scientific knowledge of medicine.”²⁸

Everyone agreed, however, that vigorous medical training for women was necessary for the promotion of scientific motherhood. Ignorance of her own body and scant knowledge in child management were taking their toll on American mothers and offspring alike. “What higher trust could be dedicated to the wife and mother,” asked Dr. Joseph Longshore in his introductory lecture to the first class at the Woman’s Medical College of Pennsylvania, “than guardianship of the health of the household?” His colleague Emmeline Cleveland, a brilliant gynecological surgeon, affirmed the necessity of giving to all women knowledge of the human body. She reminded her students that their high vocation “as nature’s appointed guardians of childhood and youth,” meant they would “become the conservators of public health and in an eminent degree responsible for the physical and moral evils which afflict society.”²⁹

Medical women like Cleveland intended to play a central role in the elevation of their sisters. As science was brought to bear on domestic life, women physicians would become the “connecting link” between the science of the medical profession and the everyday life of women.³⁰ To accomplish this purpose, each of the female medical schools offered courses in physiology and hygiene to nonmatriculants, mostly mothers and teachers hoping to gain knowledge in health education.

When critics charged that medical training was wasted on women who would eventually marry and have children, female physicians responded by pointing out that medical knowledge was important for any woman, even if the skills acquired would not be used to practice. Competence in medicine made women better mothers. A few women adopted a bolder stance by denying that motherhood necessarily conflicted with general practice. This recognition of the possibility of combining marriage and career marked a radical departure from nineteenth-century thinking. “A woman can love and respect her family just as much if not more,” asserted Dr. Georgiana Glenn, “when she feels that she is supporting herself and adding to their comfort and happiness.” Dr. Mary Putnam Jacobi agreed. Conceding that marriage complicated professional life, she nevertheless felt that “the increased vigor and vitality accruing to healthy women from the bearing and possession of children, a good deal more than compensates for the difficulties involved in caring for them, when professional duties replace the more usual ones, of sewing, cooking, etc.”³¹

Medical women also insisted that they had special contributions to make to the profession. Feminization could enhance the practice of medicine, whose goal was the eradication of suffering. Association with female colleagues would “exert a beneficial influence on the male,” making men more gentle and sensitive in their practice. Combining the best of masculine and feminine attributes would raise medical practice to its highest level. Occasionally supporters carried the implications of this reasoning even further. Female physicians expected to challenge heroic therapeutics directly. As the “handmaids of nature,” women would place greater value on the “natural system of curing diseases ... in contradistinction to the pharmaceutical.” They would promote a “generally milder and less energetic mode of practice.”³²

Some women physicians in the earliest generation consciously did spurn heroic medicine. The husband of Hannah Longshore, the first female physician to establish a practice in Philadelphia, recorded the following in a biographical sketch of his wife:

Marie Zakrzewska, who, as founder of the New England Hospital for Women and Children in Boston, earned the respect of even the most stubborn members of the male opposition, also remained skeptical of heroic dosing. In a letter to Elizabeth Blackwell she confessed that her whole success in practice was based on the cautious use of medicine, “often used as Placebos in infinitesemal [sic] forms.” Her reputation, she wrote, had been built largely on her careful use of medicine and her preference for teaching her patients preventive hygiene. “This subject is a large theme,” she concluded, “and I am thankful from the innermost of my emotions ... that nobody has ever been injured, if not relieved by my prescriptions.”³⁴

In keeping with this interest in prevention rather than cure, friends claimed that women physicians would become zealous advocates of public health and social morality. Emmeline Cleveland noted that women were naturally altruistic, while Elizabeth Blackwell expected her female colleagues to provide the “onward impulse” in seeing to it that human beings were “well born, well nourished, and well educated.” Dr. Sarah Adamson Dolley urged women doctors to bring to the profession their “moral power.” “Educated medical women,” wrote Dr. Eliza Mosher of the University of Michigan, “touch humanity in a manner different from men; by virtue of their womanhood, their interests in children, in girls and young women, both moral and otherwise, in homes and in society.” Most of their male supporters agreed. Dr. James J. Walsh admitted that men did not recognize their social duties as readily as women. “Therefore,” he confessed, “I have always welcomed the coming into the medical profession of that leaven of tender humanity that women represent.”³⁵

Women physicians sincerely believed that they would behave differently from men and that they had their own special contribution to make to society. Certainly many chose a career in medicine for more private reasons than these. Many even saw medical practice as a lucrative means of self-support. But whatever their personal motives, such women belonged to a movement that justified itself in larger terms, and they gained their self-image from the social context in which they acted. After wishing the New York Infirmary graduating class of 1899 financial success—“We are always glad to hear of a woman’s making money”—Dean Emily Blackwell urged her students to remember, “There are other kinds of success that ... we hope you will always consider far higher prizes.” These, she continued, were “the consciousness of doing good work in your own line, of being of use to others, of exerting an influence for right in all social and professional questions.” Readily conceding that her students “doubtless all entered upon medical study from individual motives,” she hoped that they had learned “that the work of every woman physician, her character and influence, her success or failure, tells upon all, and helps or hinders those who work around her or come after her.”

Forty years earlier, a younger Emily Blackwell confided similar sentiments to her diary when she thanked God that she was only twenty-five and not yet too old to commence a life’s labor full of “great deeds.” Newly decided on a medical career, she prayed that at life’s close God would grant her the ability to look back on a “woman’s work done for thee and my fellows.” Opportunities were then appearing for women to live a “heroic life,” and Emily desperately wished to avail herself of them.³⁶

While both sides in the debate over women’s role in medicine claimed to be seeking moral progress and civilization’s advancement, female physicians, like the health reformers who cleared them a path, diverged fundamentally from their conservative opponents in their commitment to using women’s abilities systematically and scientifically. Women doctors hoped to reform society by feminizing it, a task that required the professionalization of “womanhood.” Acknowledging that their goals required a broader interpretation of woman’s sphere, they felt this a small price to pay for a morally righteous and civilized America.

Nineteenth-century women doctors never drifted too far out of the ideological mainstream. As proponents of the expansion of women’s role, they perceived gradual change to be the only kind the public would tolerate. Slowly they succeeded in creating a positive image for the female physician. A minority proved that wives and mothers could handle a professional career, and the inevitable interaction with male colleagues eventually convinced many critics that women could be competent doctors and still maintain their femininity.

Female physicians largely confined themselves to what became feminine specialties—obstetrics and gynecology in the nineteenth century, pediatrics, public health, teaching, and counseling later on. Such specialization was not due solely to resistance from male professionals, although women doctors occasionally blamed discrimination. Women practitioners also gravitated to these specialties because they were conscious of their “special” abilities. They concerned themselves with the health problems of women and children because they hoped to raise the moral tone of society through the improvement of family life.

But confining themselves to women’s concerns also circumscribed women physicians’ professional influence. A few even willingly advocated an informal curtailment of their medical role, hoping to gain support by taking themselves out of competition with men.³⁷ Others disdained this approach. Such women were converted early to the modern and empirical world of professional medicine, and their first love was science. Uneasy in the moralistic world of their medical sisters, they exhibited a toughness and clarity of vision that set them apart from those women who used medicine primarily as a moral platform. Physicians like Mary Putnam Jacobi and Marie Zakrzewska insisted from the beginning that medical women needed to be of superior mettle. Fearing that specialization in diseases of women and children would mean a loss of grounding in general medicine, they warned that women would be justly relegated to the position of second-class professionals. Eventually their performance even within their specialty would become second-rate. If women would succeed in medicine, they asserted, they had to be thoroughly trained ³⁸Despite such predictions, specializing remained popular throughout the nineteenth century and into the next because it continued to provide advantages in blunting the resentment of male colleagues.

Those who stressed women’s peculiar adaptability to medicine risked perpetuating an exaggerated concept of womanhood, and their arguments proved less applicable to less obviously “feminine” pursuits. Dr. Frances Emily White attributed women’s great success in medicine compared with other professions to a “peculiar fitness” for the work and the lack elsewhere “of equal opportunities for the exercise of those qualities that have become specialized in women”³⁹ Pursuits like teaching and nursing fit the pattern well, but law did not. Though women lawyers justified their legal work in a similar fashion, it was harder for them to prove that law was an extension of women’s natural sphere; indeed, few women preferred law to medicine in the nineteenth and early twentieth centuries. The reasons for this disparity remain complex, but the “natural sphere” argument did exhibit vexing limitations as women moved out of the home and into the world. ⁴⁰

A few individuals struggled uncomfortably with the implications of such reasoning. The journalist Helen Watterson, for example, denounced the woman movement’s emphasis on “woman’s qualities.” Mary Putnam Jacobi quipped that “recently emancipated people are always bores, until they themselves have forgotten all about their emancipation.” And Marie Zakrzewska frowned upon women who chose medicine out of female “sympathy.” The only motives the profession permitted its votaries, she maintained, were “an inborn taste and talent for medicine, and an earnest desire and love of scientific investigation.”⁴¹

Jacobi remained particularly sensitive to the psychological disadvantages that hampered women physicians from attaining equal status within the profession. Society was still against them, impairing both their own confidence and that of other women in them. Because society refused to judge medical women by their achievements, women doctors were in danger of setting lower standards for themselves. In the nineteenth century any woman who ventured beyond the domestic role was considered an anomaly. To spur them on, Jacobi insistently urged her students to measure themselves by the highest standards of professional excellence: “If you cannot learn to act without masters,” she warned them prophetically, “you evidently will never become the real equals of those who do.”⁴²

By the late nineteenth century, thousands of young women would wrestle with the meaning of Jacobi’s words, and for none of them would success come without a price.