A year later Mary Putnam [Jacobi] took a degree at the Woman’s Medical College of Pennsylvania. Hoping to supplement her meager theoretical teaching with clinical experience, she spent several subsequent months at the New England Hospital for Women and Children in Boston.² In the end her dissatisfaction with both institutions confirmed Blackwell’s assessment of the opportunities then available to women. She chose in the fall of 1866 to seek advanced study in France. There she lived and studied until 1871, when she became the second woman to receive a degree from the École de Médecine in Paris, graduating with high honors and winning a bronze medal for her thesis.³

Other women also studied in Europe. In August 1860 Emmeline Cleveland, a member of the faculty of the Woman’s Medical College of Pennsylvania since her graduation in 1855, was sent to the school of Obstetrics at the Paris Maternité for postgraduate work by a group of Quaker women planning to endow a hospital at the college. After a year she received her diploma, along with five prizes, two of them firsts, and an honorable mention for excellence in clinical observation. She then briefly toured wards and lecture rooms in London and Paris, returning to Philadelphia with advanced professional training and newly acquired skills in hospital management. There she took up the chief residency of the Woman’s Hospital, newly chartered by the medical college. Years later, Jacobi judged Cleveland a “woman of real ability” and the “first adequate teacher to appear in the school.”⁴

Until the end of the nineteenth century, orthodox medical schools remained frustratingly slow to admit women. By 1893 only 37 out of the 105 regular institutions accepted them. Many of these were part of the major state universities, most of which were founded after the Civil War and were obligated by their charters to provide coeducation.⁵ Impatient with the sluggishness of the profession’s response, women founded five orthodox colleges and a handful of sectarian women’s medical schools between 1850 and 1900. Separate education, however, was not the preference of leaders of the movement, who insisted on equal access with men to professional training. Consequently, each of the five most successful female medical colleges was established in response to the exclusionary policies of men’s schools in the area.

As we have seen, women physicians generally advocated their own conception of the conventional doctrine of separate sexual spheres, claiming that women had a role in medicine by virtue of their special abilities to nurture, abilities that would compensate for and be complementary to the role and achievements of men. “The meaning of the medical movement amongst women in America,” wrote Elizabeth Blackwell in 1860, “is the felt necessity for the education of women in Science.... It is the full cultivation of the natural powers of a large number of intelligent women, for the purpose of occupying positions which men cannot fully occupy, and exercising an influence which men cannot wield at all.”⁶ Such women intended to create a professional role that could bridge the gap between public and private life. This entailed applying domestic values to larger communal concerns and utilizing the scientific and technical advances made in the public realm for improving life in the home.

On the issue of coeducation, however, regular women physicians—who became the primary publicists for women’s medical education after the Civil War—were much less willing to comply with convention.⁷ As the profession itself grew more acutely conscious of the status and quality of medical care in the United States and worked systematically to limit sectarian activity and to gain control over definitions of professional status, these women responded by carefully scrutinizing the quality of women’s medical education. They worried that separate institutions for women, lacking in facilities and experienced teachers, would prove inferior and thus established them with considerable reluctance and internal conflict. When debating the state of women’s medical education in 1860, the trustees of the New York Infirmary for Women and Children argued that “no system of separate institutions,” could ever be as valuable as giving women the opportunity to share “the accumulated experience of the profession in public institutions and receiving the stimulus and guidance and companionship of men in the acquisition of knowledge.”⁸

Four out of the five major women’s medical colleges were founded only after existing male institutions failed to accept female students. In New York, for example, Elizabeth Blackwell and the trustees of the New York Infirmary worked vigorously to convince established schools to take female applicants. Uneasy at the pending appearance of a homeopathic woman’s medical college in the city, prestigious physicians who favored regular medical education for women urged Blackwell to start her own school. Blackwell decided to go ahead with plans for a Woman’s Medical College attached to the New York Infirmary, but she regretted the necessity for the move. She and her female colleagues at the hospital “felt very strongly the advantage of admission to the large organized system of public instruction already existing for men; and also the benefits arising from associating with men as instructors and companions in the early years of medical study.”⁹

Mary Putnam Jacobi, a teacher for the next several decades at the Infirmary Medical School and probably the most highly respected woman physician of her time, was even more blunt about the rewards of coeducation. “There is no manner of doubt,” she wrote, “that ... coeducation in medicine is essential to the real and permanent success of women in medicine. Isolated groups of women cannot maintain the same intellectual standards as are established and maintained by men. The claim of ability to learn, to follow, to apply knowledge, to even do honest original work among the innumerable details of modern science, does not imply a claim to be able to originate, or to maintain by themselves the robust, massive intellectual enterprises, which, in the highest places are now carried on by masculine strength and energy.”¹⁰

Indeed, the women’s medical colleges labored under a stigma of inferiority which was sometimes internalized and perpetuated by women doctors themselves. Bethenia Owens-Adair, who in the early 1870s had attended Penn Medical University, a sectarian institution in Philadelphia, decided after a few years’ practice in Oregon that she needed a regular medical degree to advance her status. She decided to return to Philadelphia to attend Jefferson Medical College, a bastion of male privilege which did not open its door to women until 1961. When Owens-Adair arrived in the city, she sought an interview with Samuel Gross, a well-known surgeon and distinguished member of the Jefferson faculty. Hearing of her plans, Gross cordially regretted that although he would “gladly open the doors of Jefferson” to her, the board of regents had the power “and they are a whole age behind the times.... Why not go to the Woman’s College?” he queried. “It is just as good. The examinations ... are identically the same.” Owens-Adair’s reply spoke volumes: “I know that, Professor Gross,” she answered, “but a Woman’s College out West stands below par, and I must have a degree that is second to none.” “Then the University of Michigan is the school for you,” Gross concluded.¹¹

Owens-Adair took Gross’s advice and went to Michigan, as doubts about women’s capacity to withstand the rigors of medical training plagued other female medical educators. Given their mistrust of female abilities, it is a wonder they pressed so hard for coeducation. Once the women’s medical schools were established, for example, they attempted to provide compensatory education to students, reasoning that women were not yet used to the discipline of science. “It was realized ...” remembered Jacobi of the New York Infirmary, “that the best way to compensate the enormous disadvantages under which women physicians must enter upon their work, was to prepare them for it with peculiar thoroughness. Women students were almost universally deficient in preliminary training: their lesser physical strength rendered a cramming system more dangerous to health and more ineffective as a means of preparation....” Blackwell, too, was aware of what she termed “intimate sources of difficulty.” “Women have no business habits: their education is desultory in its character, girls are seldom drilled thoroughly in anything; they are not trained to use their minds any more than their muscles; they seldom apply themselves with a will and a grip to master any subject.”¹²

The decades after 1860 were regarded as a trial period in which women, barred for the most part from men’s schools, would prove that they were, in Jacobi’s words, made of “superior mettle.”¹³ All but one of the woman’s colleges struggled valiantly and for the most part successfully in these years to establish and maintain professional standards that would remain beyond the reproach of male colleagues. The task was a monumental one, especially when the profession itself was taking a long, hard look at the deficiences of medical education.

As proprietary medical schools founded to turn a profit multiplied in the midnineteenth century, these institutions drastically reduced the standards of medical education in the fierce competition for students. Some faculties shortened lecture sessions to enable students to receive the degree after nine months of attendance ; other schools virtually abolished preliminary educational requirements, and clinical training at all but a select few remained scant. Although technically most schools still demanded one year of clinical apprenticeship with a private physician before issuing the degree, the preceptorial requirement had virtually broken down by 1850, so that in many places students were no longer obligated to submit preceptor’s certificates.

The multiplication of colleges, the decline in standards and the consequent decrease in the quality of medical practice worked to undermine the prestige of physicians as a group. In his opening address to the American Medical Association in 1869, president William O. Baldwin spoke of a deteriorating system of education. “Any man can enter a medical college in this country without having gone through even the jest or mockery of spending a year in a private preceptor’s office,” he complained. Many colleges admitted students for “simply paying the fees required.” Those who so desired would “attend the lectures and hold private quiz-clubs to familiarize themselves with the material,” while many of the other students attended the “lager-beer saloons and theatres at night.” Because of low standards, he concluded, it was “but a short step from the plough-handles to the diploma.” Similarly, Steven Smith recalled that it was a common saying among the townsfolk of Geneva, New York, where he took his degree “that a boy who proved to be unfit for anything else must become a Doctor.”¹⁴

The founding of sectarian institutions that admitted women students exacerbated already bitter feelings in the regular profession regarding allegations of poorly trained men. The Penn Medical University in Philadelphia, for example, boasted several prominent eclectic physicians on its faculty, and graduated well over a hundred women from its Female Department between 1853, when it was founded, and 1881, when it finally succumbed to financial pressures. Even more distasteful to the regulars was Russell T. Trall’s New York Hygieo-Therapeutic Medical College, chartered by the state legislature in 1857. Trall, the editor of the Water-Cure Journal, trained dozens of hydropathic physicians every year, many of them couples who left for the West to found water-cure establishments. His school also recruited women students in the pages of the feminist journal The Revolution and offered them scholarships.¹⁵

This situation prompted a reform-minded minority to take steps to deal with the problems facing the entire medical community. Concerned professionals had organized the American Medical Association in 1846, and shortly afterward members formed a committee on medical education to study the problem and recommend measures for improvement. Investigation of the regular schools revealed a dismal picture. A report stated that only twenty-two of the thirty-eight colleges had seven or more professors; a mere four had terms of six months or longer, less than half required dissection, only a handful demanded hospital attendance, and at least ten schools had abolished the required certificate from a preceptor.¹⁶

In 1847 and again in 1867 the AMA Committee on Medical Education published a series of guidelines for its member colleges. In the first report the committee recommended a six and one-half month term, three years of study, required dissection, clinical instruction, a faculty of at least seven members, and more stringent preliminary education standards. Twenty years later a second report added to its recommendations a graded curriculum, yearly examinations, and an increase to nine in the number of required professors. ¹⁷

It was in the midst of this crisis over medical education that the women’s medical schools were founded. Thus, the debate over women physicians almost naturally became intertwined with the one over raising medical standards. The connection in the minds of many male physicians became apparent particularly in discussions in the 1860s and early 1870s surrounding the admission of women to membership in the medical societies. Opponents claimed that women were poorly trained, and that the lowering of professional standards involved in admitting inferior members hurt the status of their professional organizations. Jealously guarding their professional image; many physicians used inadequate schooling as an iron-clad excuse for barring women from membership.¹⁸

Lurking beneath the surface of the debate over raising standards was the more elusive objection to men and women studying medicine in mixed classes. Although some men undoubtedly supported separate women’s schools as an excuse to exclude females from the mainstream of the profession, others gave every evidence of a genuine respect for female achievements. Not all male opposition to coeducation can be attributed to the irrational disapproval of women doctors. Many like Henry I. Bowditch and James Chadwick of Boston were more than willing to see women educated, so long as it was done in separate institutions of comparable quality. “To say that men and women should be educated in medicine separately,” wrote an anonymous Chicago correspondent to the Boston Medical and Surgical Journal in 1878 “is no disparagement to women students, nor is it opposition to the free and equal entry of women into the profession. It is simply a deference to an almost universal feeling of the sexes toward each other—a feeling with which from childhood up we are indoctrinated by the civilization of our time.” Like Bowditch, this commentator was quite satisfied to see men and women doctors working together as clinicians, but only after they had received the M.D. degree, for only then was it possible for physicians to “meet each other on a basis of high ethics and science and forget sex.” The problem, explained the writer, was that “students are not physicians.” Male students in particular needed “time ... to develop,” and for that reason, he claimed, Chicago’s experiment in coeducation had proved short-lived. Instead, Chicago had done much better by establishing a separate but equal school for women. To nineteenth-century ladies and gentlemen, the question of men and women studying the human body together in the same classroom remained a delicate issue and a deterrent to admitting women to existing schools on an equal basis with men. Even at Michigan—the first university to admit women in a coeducational atmosphere—women attended some classes separately, and well into the first decades of the twentieth century many coeducational schools arbitrarily “excused” women from their all-male urology clinics.¹⁹

Though women physicians generally remained unwilling to challenge too many Victorian sensibilities, they had few second thoughts about the importance of coeducation to the future of women in medicine, and demonstrated little tolerance for such arguments when discussing them among themselves. Yet careful strategy dictated that they give due respect to objections raised on the grounds of delicacy. Marie Zakrzewska, who wanted to see women integrated into most of the classes at Harvard much as they were at Michigan, stubbornly hung back from making unrealistic demands in order to keep key supporters like Henry Bowditch and James Chadwick, prominent members of Boston’s medical elite, in her camp. Thus, she upbraided the feminist Caroline Dall in 1867 for the publication of an overly aggressive article demanding the admission of women to Harvard Medical School. Dall had proposed the erection of new classrooms and dissecting laboratories to accommodate women, and Zakrzewska warned that her ill-conceived remarks “thrown out to the public” would give both physicians and laymen an excuse for opposing the admission of women. Better to concentrate on the right of women to study, she cautioned, and “keep quiet about all minor arrangements until the admission is effected.”²⁰

But the complicated and contradictory arguments raised by the opposition to women physicians condemned female medical educators in this period to the thankless task of maneuvering themselves in and around objections put forward by the more vocal members of a profession that collectively proved to be decidedly less than cordial to their efforts. Yet the bitterest irony in this story concerns women doctors’ successful efforts to establish medical colleges of their own. In the 1860s they had pleaded to be admitted to men’s institutions on the grounds that the fledgling women’s schools that existed were producing ill-trained physicians. When their efforts failed, women like Elizabeth Blackwell and Mary Putnam Jacobi, who had themselves been so critical of opportunities for women to study, solved the problem by founding new schools and improving the old ones. By the 1880s students at the regular women’s medical colleges were receiving an education comparable to men at the best schools.

Though some male physicians had opposed coeducation on the grounds of Victorian delicacy, by far the most common argument hurled against women physicians by the medical societies in the 1860s and 1870s was their inferior training. When the women’s schools started to succeed, the opposition perversely switched ground. In a series of articles in 1879 expressing mock surprise at women physicians’ self-confessed inferiority, the Boston Medical and Surgical Journal berated them for demanding to be admitted to Harvard Medical School. Now, however, the editors opposed such a move, not on the grounds of women’s inferior instruction, but rather because of the “universal opinion of the profession,” which was “decidedly and strongly against the coeducation of the sexes in medicine.” The editor went on to examine carefully the curricula at the women’s medical colleges in New York and Philadelphia, declaring that they exhibited a “standard of examinations as good as that at the best colleges.” Women did not need to be admitted to Harvard, he concluded, because they had first-rate institutions of their own.²¹

The fact was that the editor of the Boston Medical and Surgical Journal was correct in his evaluation of the women’s schools. By the end of the 1880s four of the five most successful of them offered what must be judged an adequate or even superior medical course, particularly when compared to the other vanguard contemporary institutions which were slowly responding to AMA guidelines.

From the day the Woman’s Medical College of the New York Infirmary opened its doors, for example, it complied with almost all of the AMA’s suggested reforms. The Blackwell sisters founded the school in 1868, ten years after they set up the Infirmary itself, a small but efficient woman’s and children’s hospital originally located on the edge of the Five Points district in New York City.

The Infirmary had grown gradually out of Elizabeth Blackwell’s struggles to establish herself as a woman practitioner in the city. In 1852 she began there after two years’ study in France and England. Patients materialized at a snail’s pace, and Blackwell’s mounting discontent with both a desultory practice and the lectures on physiology she gave to women and girls to fill up her time and pocketbook led her to approach several of the city’s dispensaries, hoping to win a place in the Women’s Department. No one would hire a woman physician, and medical friends urged her to establish her own institution. ²²

Blackwell gathered support for the endeavor from many prominent Quakers and reformers in the city. Her friends included the lawyer Charles Butler, journalists Charles A. Dana and Horace Greeley, Theodore Sedgwick, the lawyer son of the prominent Federalist of the same name, publisher Stacy B. Collins, reformer Marcus Spring, and the Reverend Henry Ward Beecher.

The dispensary opened in 1854. Blackwell was joined by her sister Emily, and later by Marie Zakrzewska, an immigrant German midwife who would soon earn a medical degree and subsequently found the New England Hospital for Women and Children. In time Zakrzewska also became a leader among women physicians in America.

In 1857 the original dispensary was expanded into a full hospital, according to Blackwell’s ambitious plan to give fledgling women physicians bedside clinical experience. In the next decade the Infirmary received a number of graduates from Philadelphia and Boston who stayed for six months to a year for clinical training. Several of these women—Mary H. Thompson and Annette Buckel, for example—went on to found their own hospitals patterned after the Infirmary in cities in the Midwest and West. All such hospitals shared a threefold purpose: to provide medical and surgical assistance to women and children in need, to train an efficient body of nurses for community service, and to provide a clinical atmosphere where newly graduated women physicians could receive bedside instruction.²³

The Blackwell sisters understood the importance of maintaining the highest professionalism in all their endeavors, and were careful not to allow any of their activities to be tainted with accusations of sectarianism. Marie Zakrzewska recalled constant applications from students for clinical experience, many from people she termed “all sorts of extremists ... such as women in very short Bloomer costume, with hair cut also very short, to whom patients objected most strenuously.” Others had been trained in water-cure establishments “and wished to avail themselves of our out-door practice in order to introduce their theories and methods of healing.” All such candidates were refused on the grounds that “popular prejudices could be overcome only in the most careful and conservative manner.”²⁴ Later, the New England Hospital for Women and Children would bar homeopathic women physicians for similar reasons. Indeed, Blackwell’s contempt for sectarian women practitioners is particularly pronounced in her private correspondence, especially when she speaks of Clemence Lozier and the New York Medical College for Women. Lozier was extremely active in women’s rights circles, and her homeopathic medical school, founded a few years before Blackwell’s, competed with the Infirmary for students. Certainly some of Blackwell’s hostility can be attributed to personal pique at being upstaged, but equally important was her hardheaded assessment of the most efficacious way for women to make their way in the profession.²⁵

In the early years before the establishment of the medical school, the Infirmary enjoyed the support of a number of prominent physicians in New York City. Valentine Mott, a leading surgeon at Bellevue Hospital, became a consulting physician until his death in 1865. Another consultant was Dr. John Watson, an attending surgeon at New York Hospital. Willard Parker, Steven Smith, and Isaac E. Taylor, all conspicuously active in the Academy of Medicine and the New York County Medical Society, not only served as consulting physicians to the hospital for many years, but also held places on a special Board of Examiners created with the establishment of the medical school. Thus, although medical opinion had not yet reached the point where women could be admitted as residents to existing dispensaries, women physicians in New York were not without medical friends.

The Infirmary’s Annual Report of 1862 reveals dissatisfaction on the part of Blackwell and other trustees with the medical training of the women students who came to work there. After a lengthy discussion, the Board of Trustees decided to create a fund that could be used to “procure a thorough course of medical lectures for women in connection with some well-established college.” Members felt this to be the “most economical means of securing a complete education,” believing a separate school for women to be too expensive and hoping that the major contribution of the Infirmary would be “to gain the attention and respect of the community and win that confidence from the profession which will induce them to receive its students into their wider opportunities.”²⁶

Attempts to use the fund at New York schools were rebuffed, however, and when rumors began circulating that New York City would soon have a new homeopathic medical school for women, Blackwell’s professional friends urged her to found her own college, pleading that women’s “medical education should not be allowed to pass into the hands of ... irresponsible persons.”²⁷

When the Infirmary’s medical school opened six years later, it reflected Blackwell’s high standards of medical education. It introduced a number of curricular innovations—a required three-year course; a progressive, graded curriculum; a Board of Examiners consisting of some of the most distinguished male physicians in the city which passed on every student graduating from the school; the first course in Hygiene (preventive medicine) offered anywhere in the country; and obligatory hospital residence or medical work under the supervision of various clinics for all candidates for graduation. The faculty included seven male and three female physicians for a student body numbering seventeen. Not until 1871 did Harvard make similar innovations in its course offerings, and the University of Pennsylvania did not follow suit until 1877.²⁸

Faculty minutes suggest that the institution never wavered from its original high standards. Students were barred from graduation if they failed their examinations, and occasionally were asked to leave if their preliminary education made it clear that they could not perform adequately.²⁹

By 1874, when the term was lengthened to six months and a three-year course became obligatory, the school stood at the forefront of the movement for higher standards. The college continued to make curriculum changes throughout the century and its clinical teaching proved innovative. Meanwhile, few of the male medical schools altered their policies in accordance with AMA standards because when they did they invariably lost students. Only five medical schools—Chicago Medical College, Harvard, the University of Pennsylvania, Syracuse, and the coeducational University of Michigan—managed to lengthen their terms and institute a three-years’ graded course by the end of the 1870s.³⁰

Blackwell deemed it essential to preserve friendly relations with male physicians. “It must not be taken for granted,” she reminded her supporters, “that the exclusion of female students from medical colleges and public institutions indicates a settled hostility to the movement.” The new medical school would continue to help women form “links with the profession.” And indeed, many prominent medical men spoke highly of the college. In 1911 Dr. Steven Smith reminisced that during the same years that he was a member of the Infirmary’s Board of Examiners he was also a professor in a men’s medical school. “As to the qualifications of the two classes, both technical and practical,” he confessed, “the graduating classes of the women’s school generally averaged the highest.” He felt the Infirmary “took rank with the best medical schools of the country.”³¹ William Welch, also a member of the Examining Board in his early career, admitted years later to Dr. Josephine Baker, “I am now ashamed of the type of questions we required those young women to answer. I am sure no one would have tolerated them in our own colleges. But our excuse must be that Dr. Blackwell demanded more difficult questions than could be submitted to our students, for she was determined that all women graduated from her college should be a carefully selected group. ”³²

Because they labored under greater financial burdens, three of the four major women’s medical colleges were slower than their sister school in New York to improve curriculum, but all of them boasted a respectable program well in advance of the majority of medical schools. In 1850 a group of liberal Quaker physicians and businessmen founded the Woman’s Medical College of Pennsylvania. Several of the doctors—N.R. Moseley, Hiram Corson, Bartholomew Fussel, and Joseph Longshore—had already been acting as medical preceptors to a sizeable group of Quaker women who wished to study medicine. When it became clear that no medical school in the city would admit female students, the doctors founded a college of their own. The semester opened with six faculty members teaching forty matriculants. A year later eight students received M.D. degrees.³³

The Woman’s Medical College of Pennsylvania labored under the collective hostility of the Philadelphia medical community for almost two decades. Until 1871 the state medical society refused to recognize its graduates, adhering to a resolution passed in 1860 barring members from consultation with the school’s faculty or alumnae.³⁴ Though members deliberately ignored this resolution, and no violating physician was ever formally disciplined, the repeated efforts of friends of the school to gain admission and recognition for female graduates on both the county and state level met with defeat until the middle of the 1870s. “For a medical man to be connected at that time with the Woman’s Medical College required pluck.” recalled Dr. Henry Hartshorne, a professor at the school and in the 1880s a faculty member at the University of Pennsylvania as well. Dr. C. N. Pierce, an original incorporator of the school confirmed Hartshorne’s recollection when he reminisced to Dean Clara Marshall in the 1890s:

In spite of the problems, the small but respectable faculty determined to prove that women could study medicine and were as careful as Elizabeth Blackwell in New York to make the institution professionally acceptable. The school rid itself of the suspicion of sectarianism when two members, regularly trained but partial to eclecticism, resigned in 1854. Female professors took their places on the teaching staff as soon as properly educated women became available. In 1866 Dr. Ann Preston, a member of the first class, was appointed dean. As we have already seen, another professor, Emmeline Cleveland, was sent to Europe for training in surgery, gynecology, obstetrics, and hospital management.³⁶

Maintaining high standards was a constant concern. The college announced a graded curriculum only a year after it was offered at the New York Infirmary in 1868, although the change did not become obligatory until 1881. In 1871 students were urged to attend an eight-month term, although again a lengthened course was not required until ten years later. Entering students were required, however, to present a diploma from an advanced preparatory school or to take an entrance examination. A three-year course was instituted only four years after it was required by the University of Pennsylvania, while trustees added new laboratory equipment as needed. As late as 1895, for example, the Woman’s Medical College of Pennsylvania was the only school besides Johns Hopkins to require work in the physiology laboratory. The faculty began yearly examinations for course work early in the college’s history and joined with five other schools—Harvard, Michigan, Chicago Medical College, and the New York Infirmary—in requiring a four-year course as early as 1893.³⁷

The dean’s correspondence also displays evidence of the desire to maintain high standards. Letters to Harvard and the New York Infirmary in the 1880s and the 1890s inquiring about educational policy indicated a concern to be at the forefront of educational innovation. The college was an early member of the Association of American Medical Colleges and sent two delegates to its convention every year.³⁸

Indeed, the school did a remarkable job despite its persistent handicap of limited funds. But lack of money was always an irritant. Writing to Charlotte Blake Brown, a distinguished graduate who settled in San Francisco and founded the Woman’s and Children’s Hospital there, Dean Clara Marshall responded in 1890 to some friendly criticism Brown had offered on a recent visit to Philadelphia:

By the mid-1870s the early opposition to women physicians in Philadelphia had abated slightly. One conspicuous change was the admission of women students to clinical opportunities elsewhere in the city. In 1869, for example, Alfred Stillé, the distinguished surgeon and later president of the AMA, welcomed women to his lectures at the Pennslyvania Hospital, remarking publicly, “I not only have no objection to seeing ladies among a medical audience, but, on the other hand, I welcome them.” Women were admitted to private classes on the medical wards at Blockley in 1878. Early in the 1880s they began attending regular weekly clinics at the Pennsylvania, Wills’ Eye Hospital, the Bedford Street Mission, and the Eye and Ear Department of the Philadelphia Dispensary. Clinical positions also became possible to obtain for the first time. Emmeline Cleveland was appointed gynecologist to the Department of the Insane of the Pennsylvania Hospital in 1878, and two years later her student Alice Bennett took a job as the first female medical superintendent in the Department for Women at the Norristown State Hospital. Blockley began accepting women interns after 1883, and in the next decade women became assistant physicians and pathologists at other city and state institutions. ⁴⁰

The desire to develop a special role for women in medicine also led the New York Infirmary and the Woman’s Medical in Philadelphia to important clinical innovations. A recent study of the teaching of obstetrics has revealed that this branch of medical education lagged pitifully behind other subjects. In most institutions midwifery teaching consisted solely of didactic lectures. In contrast, Dr. Anna Broomall organized an out-patient department connected to the Woman’s Hospital of the Woman’s Medical College of Pennsylvania in 1876. Eventually this department offered the first prenatal care in the country. Each medical student was responsible for the independent management of at least six obstetric cases before she was graduated. The New York Infirmary provided a similar experience in obstetrics and gynecology. The 1888 faculty minutes refer to a requirement demanding that every student attend at least twelve cases before graduation. ⁴¹

The city of Chicago gained a woman’s medical college in 1870, after an inconsistent history on the question of women physicians. In 1851 Emily Blackwell was accepted as a student at Rush Medical College and attended classes for a year, but when the medical society put pressure on Rush, the school denied Blackwell readrnission to finish the two-year course. No other women gained acceptance to regular schools in Chicago until Mary Harris Thompson arrived there during the Civil War. Thompson had earned a medical degree from the New England Female Medical College and had settled in Chicago because it seemed to offer still-unexplored opportunities for a woman physician in practice. In 1863 Thompson befriended Dr. William G. Dyas and his wife Miranda, both actively engaged in service as members of the U.S. Sanitary Commission. Thompson soon became interested in the plight of war widows and orphaned children, and with the help of the Dyases she founded a small hospital patterned after the New York Infirmary, where she had interned.

Dissatisfied with the medical training she had received in Boston, Thompson also planned to enter Rush Medical College for postgraduate work. When her attempts to gain admittance failed, she turned to Dyas, who put her in touch with a sympathetic faculty member at Rush’s rival medical school, the Chicago Medical College. Through the influence of Professor of Obstetrics and Gynecology William H. Byford, who rapidly became a loyal supporter of female medical education in Chicago, Mary Thompson and two other women who were just beginning their training were admitted for the 1869-1870 sesion at Chicago Medical.

Thompson completed her work in a year and received a second diploma, but the other two women were not as fortunate. Complaints from male students that mixed classes hampered the teaching of important but delicate subjects prompted the college to ask the remaining female students to leave before they could begin their second year. Byford, who had become a close friend of Thompson’s, was mortified, and together they formed a committee that organized the Woman’s Hospital Medical College in 1870. The faculty of the new school consisted primarily of the consulting staff of Mary Thompson’s hospital. Its Board of Trustees numbered several prominent Chicago reformers and clergymen, and a handful of physicians sympathetic to women.⁴²

Like the Woman’s Medical College of Pennsylvania, the Chicago school labored under a small endowment and struggled valiantly to provide adequate training. The faculty contained several respectable male physicians, including Dyas and Byford himself, who retained an active interest until his death in 1890. Despite the school’s handicaps, it managed to turn out a whole generation of prominent women physicians in Chicago who ultimately took places on the faculty: Marie J. Mergler, Sarah Hackett Stevenson, Frances Dickinson, Mary E. Bates, and many others.

Like their counterparts in New York and Philadelphia, Byford and Thompson were careful to comply with AMA guidelines as quickly as possible. The school opened with a large faculty of seventeen. It required both dissection and clinical instruction from the start, and although a graded curriculum was not made obligatory until 1876, students were strongly advised to take a progressive course, which was conveniently divided into “Junior” and “Senior” sections. Yearly examinations were adopted. The term of study remained only five months initially, but was lengthened to seven in 1883. The faculty urged students to pursue a three-year course, though it required only two years until 1890. Clinical and laboratory work, including practical obstetrics, pathology, chemistry, and histology was required early in Chicago, as in all but one of the women’s colleges.⁴³ By the 1880s, the school had gained such a worthy reputation in the city that Cook County hospital opened its competitive examinations to women, and a few, including Mary E. Bates and Jeanette Kearsley, won appointments, though the hospital remained reluctant to accept more than one woman at a time. In 1892 the school merged with Northwestern University, continuing to train competent women physicians until it was closed by Northwestern’s trustees in 1902. ⁴⁴

In Baltimore a woman’s medical college was established in 1882 when a group of female philanthropists met with seven male physicians, including the uncle of the indomitable future president of Bryn Mawr, M. Carey Thomas, to open a school they hoped would offer “all the opportunities for the pursuit of knowledge that are offered to men,” within an “unrestrained” and “unembarrassed” atmosphere. The faculty immediately set the term at seven months, required final examinations at the end of each year, and instituted a graded course of instruction with the mandatory completion of a “creditable” dissection. In 1888 the course was extended from two to three years, and in 1895, to four.⁴⁵ According to Abraham Flexner, who visited the school in 1909, laboratory facilities were “scrupulously well kept.” They showed, he thought, a desire to do “the best possible with meager resources,” Although clinical opportunities existed, Flexner found these to be inadequate, but not more so than the majority of medical institutions at the time. Because no adequate history of the school exists, comparatively less is known about it than what is known of Chicago, New York, or Philadelphia. Still, its catalogues indicate that its curriculum compared favorably to the others. Unfortunately, the Woman’s Medical College of Baltimore remained dominated by men; only a few women appear on its faculty lists even as educated women professionals became available. Despite this drawback the school graduated seventy-three students by 1900. How well it did its work is evidenced by the fact that in 1890 two of its graduates won internships in Blockley hospital in Philadelphia following a stiff competitive examination.⁴⁶

The only major regular woman’s medical college that in any way deserved the accusations of inferior teaching hurled by the medical opposition was the New England Female Medical College in Boston, founded as a school of midwifery in 1848 by Samuel Gregory, an idiosyncratic and opinionated health reformer, who had no formal medical training. A Yale graduate, Gregory made his living as an itinerant lecturer and pamphlet writer. In the late 1840s he became obsessed with the growing popularity of male midwifery, and published several articles and pamphlets terming the new custom an affront to female modesty and to civilization itself. Arguing that only women should attend other women in childbirth, Gregory managed to rally to his support a mixed assortment of New England reformers, lawyers, teachers, clergy, and businessmen, including Samuel Sewall, Emerson Davis, and James Freeman Clarke. Together they organized the Female Medical Education Society, which first offered courses primarily in nursing and midwifery. In 1856 a woman’s medical school, consisting of a faculty of six men, with one woman as demonstrator of anatomy, was chartered by the Massachusetts legislature. Though two of the faculty were members in good standing of the Massachusetts Medical Society, the school’s health-reform connections were also strong: William Mason Cornell, professor of physiology, hygiene, and medical jurisprudence, also edited the Practical Educator and Journal of Health, a health periodical that was the official organ of the Massachusetts State Teachers Association.⁴⁷

The New England Female Medical College also had solid feminist ties. A Board of Lady Managers, consisting of some of the most prominent “reform” women in Boston—Mrs. Lyman Beecher, Abby May, Lucy Goddard, Ednah Dow Cheney, Harriet Beecher Stowe—actively raised money on the school’s behalf. In 1859 they enticed Marie Zakrzewska to leave the New York Infirmary to become Professor of Obstetrics and Diseases of Women and Children at the school. Zakrzewska was also appointed resident physician in a proposed hospital planned by the lady managers. Thus, the new decade opened with promise. Yet a few years later it became apparent that the New England Female Medical College would prove a disappointment to medical women everywhere.⁴⁸

One historian has suggested that the cause of failure lay primarily with “the resistance of the medical world to women.” However, a careful reading of the school’s history suggests that the explanation is not that simple. Of course all of the women’s medical schools struggled mightily with male hostility, but most of them achieved the profession’s grudging respect. The New England, unfortunately, was also burdened with Samuel Gregory’s difficult personality and his antiquated ideas about medical education. Gregory’s presence dominated trustee meetings. Minutes suggest that he devoted most of his time to school affairs, taking them up as his own private cause. He resented interference from any source on policy or financial issues and clashed with faculty, students, lady managers, and trustees over the future of the school. At issue particularly, especially with some of the faculty, was the question of standards and medical curriculum.⁴⁹

The school’s catalogues, for example, written by Gregory himself, were amateurish and rambling, lacking the professional veneer of those of the other women’s institutions.⁵⁰ Handicapped for years by a small faculty, the college could offer only a short term of study: four months. There is no evidence of a graded curriculum. Clinical facilities remained meager. Zakrzewska, fresh from the New York Infirmary, where she and the Blackwell sisters had given a great deal of thought to educating women physicians, was dismayed from the start by the lack of even the most rudimentary laboratory equipment. When she petitioned for the purchase of a microscope after her first year, Gregory rejected the request on the grounds that such equipment represented “new fangled European notions.” In 1860 such a reaction represented the most extreme form of medical conservatism.⁵¹

Zakrzewska’s autobiography chronicles her gradual disenchantment. She found that not only did physicians in Boston deny the school support because of low standards, but even women physicians educated elsewhere kept their distance from the New England. Many feared that its very existence gave women in medicine a bad name. Years later Mary Putnam Jacobi commented that “there was no one connected with [the school] who either knew or cared what medical education should be.... It offered a curriculum of instruction, so ludicrously inadequate for the purpose, as to constitute a gross usurpation of the name.”⁵²

As Zakrzewska received more encouragement from several prominent male physicians in Boston, including Henry I. Bowditch and Samuel Cabot, she realized that Gregory and the New England could become a severe liability, not only to her own career, but to the reputation of women physicians as well. Gregory consistently did battle with Boston’s medical elite. Particularly disturbing to Zakrzewska was his monograph, Man Midwifery, where he “not only challenged the prevailing method of practice but abused even the best physicians by intimating the grossest indelicacy, yes, even criminality in their relations with their patients. This was the reason,” she concluded, “why no physician in Boston would openly acknowledge me as long as I remained in connection with the New England Female Medical College.”⁵³

Equally frustrating was her campaign to raise the school’s standards, especially when she realized that she would not be supported by a united faculty, some of whom believed that they were already “teaching all that a woman doctor ought to know.” Zakrzewska also criticized the poor preparatory education required from entering students. While a few had the “best of education,” too many others fell far below standard. These latter she could not in good conscience “consider ... fit subjects to enter upon the practice of a profession which requires so much knowledge in various scientific directions as well as a broad education, so as to enable one to comprehend the effects of all kinds of environment upon the individual patient.” In addition, Zakrzewska had difficulty convincing such students of the importance of clinical training, something which she had come to consider, particularly because of her association with the Infirmary, as absolutely essential. Yet the trustees continued to make entrance requirements as lenient as possible in order to attract students. ⁵⁴

When her position became “tedious in its teaching duties and unendurable in its relation to the students,” Zakrzewska resigned. In 1862 she left the school, taking with her a number of students and trustee supporters who helped her establish the New England Hospital for Women and Children. In doing so she surrendered her hopes of teaching undergraduate medical students, and devoted herself instead to building a hospital which would offer coveted clinical instruction to women medical graduates for the next half century.⁵⁵

Years later Zakrzewska lamented her difficulties with Gregory, complaining that “had the originator of the school ... been a man of higher education and broader views, the school might have been taken up by the men standing highest in the profession. The prevailing sentiment among these men seemed to be that if women wanted to become physicians, the trial should be made by giving them the same advantages as were offered to men students.” For herself, she viewed the struggle over higher standards in the early 1860s as “the beginning of the end of the college.” She stubbornly refused to grant women medical diplomas simply because they were women, arguing that “perseverence alone does not entitle persons to receive a diploma.”⁵⁶

Acutely sensitive to the reputation of women physicians, Zakrzewska steadfastly held back from open disagreement with the trustees, understanding that any public controversy would involve the school in a “notoriety absolutely fatal to the whole cause.” When she resigned in 1862, however, she wrote them a bitter letter, summing up the feelings of many concerned women educators. If it were the intention of the trustees, she observed, “to supply the country with underbred, ill educated women under the name of physicians in order to force the regular schools of medicine to open their doors for the few fitted to study, so as to bring an end to an institution from which are poured forth indiscriminately ‘Doctors of Medicine,’ I think the New England Female Medical College is on the right track. ”⁵⁷

After she left, internal dissention continued to cause problems for the school until Gregory’s death. Shortly afterward, financial problems forced the institution to merge with Boston University and become homeopathic, a move that drew contempt from female regulars. Mary Putnam Jacobi, for example, could not hide her delight when the New England was finally “extinguished as an independent institution” in 1873.⁵⁸

Female medical educators articulated by word and by deed two primary goals. On the one hand they strove to make women physicians as “professional” as possible, demanding that students comply with, if not surpass, the highest standards of excellence for men. On the other, they sought to preserve for women a “special” role in medicine, hoping to channel their intellectual energies into service appropriate to nineteenth-century conceptions of woman’s sphere.

Most women physicians clung to a belief in the necessity of coeducation largely because they doubted women’s ability to create separate institutions commensurate with male standards. Although a retrospective study of the major women’s schools suggests that such doubt was unfounded and that most of these institutions performed valiantly despite their enforced isolation from the mainstream of American medicine, the majority of female educators established the women’s colleges as “cautious experiments.” Most women physicians came to view them as valuable merely as a temporary means of proving women’s competency in medicine. Only the Woman’s Medical College of Pennsylvania seemed curiously oblivious to such short-term goals and quite certain of its own future significance in remaining a woman’s school.⁵⁹

Other women’s schools, however, were profoundly influenced by the opening of Johns Hopkins medical school in 1892. The establishment of the Baltimore school marked the beginning of an era of considerable consequence in the history of American medicine, while its willingness to admit women on the same terms with men marked an even more crucial event for the history of women in the profession.

The Johns Hopkins University had come into being in 1876 very much because of the vision and foresight of a benefactor and namesake whose educational philosophy was as innovative as his financial contribution was vast. Reviving and improving on the eighteenth-century Scottish tradition of university medical schools, Hopkins wanted a hospital subordinated to the needs of a medical school with both institutions intimately connected to a university. Medical teaching was to utilize and depend on the resources of an up-to-date hospital, while the university itself would be modeled after the system of German higher education. Hopkins’s first president, Daniel Coit Gilman, was instructed to canvass and recruit the best teachers and scholars in the United States and western Europe. The result was a highly cosmopolitan group in the original faculty of philosophy: not one man was a native Marylander, and two, the mathematician J. J. Sylvester and the brilliant young physiologist H. Newell Martin, came from England. ⁶⁰

Initially, the University’s trustees had agreed with President Gilman that coeducation would unquestionably threaten the goals of the new institution, and women were consequently barred from admission. Although several midwestern institutions had reluctantly succumbed to the financial pressure of declining enrollments and recently accepted women students, the larger endowments of eastern private universities, coupled with the establishment of a handful of excellent women’s colleges after the Civil War, allowed schools like Harvard, Princeton, Columbia, and Yale to delay the admission of women indefinitely. In 1882 this policy forced Martha Carey Thomas, a graduate of Cornell and the daughter of an influential Hopkins trustee, to obtain her Ph.D. in Zurich, when a year of unsuccessful negotiations could not move the trustees to grant her permission to earn a Hopkins degree. Thomas, proud and imposing, never forgave the university for her humiliation, and it was not long before events conspired to grant her a measure of revenge while opening up a unique opportunity for all women.

The new Johns Hopkins Hospital, designed by Dr. John Shaw Billings and infused with an innovative intellectual spirit by Dr. William Welch, opened its doors in 1889, thirteen years after the founding of the university. Only the completion of the medical school was now awaited to fulfill the vision of its benefactor. But funds intended for this purpose, which since 1880 had been tied up in the fluctuating fortunes of the Baltimore and Ohio Railroad, were not readily forthcoming between 1889 and 1891. In the year the hospital opened, the railroad had ceased to pay dividends at all to its stockholders. Though the key figures of the medical faculty—Welch, Halsted, Osler, and Kelly—had all been appointed, naysayers worried that there would be no school of medicine.

It was at this point that the future of the most innovative institution in the history of modern American medicine became intertwined with the advance of feminism. Under the rigorous and determined leadership of M. Carey Thomas, now dean and professor of English at Bryn Mawr College, four Baltimore young women—all of them the daughters of Hopkins trustees—seized upon the school’s financial dilemma as a means of promoting the cause of women.

Thomas and her friends Mary Elizabeth Garrett, Mary Gwinn, and Elizabeth King proposed to take on the task of raising the money needed. Within a year, a national Woman’s Fund Committee had been set up throughout the country to tap existing female networks—both women of family and wealth and women of intellect—and to establish new ones. ⁶¹

Partly through the $50,000 contribution from Miss Garrett, the shrewd daughter of the president of the Baltimore and Ohio and his trusted advisor in business affairs, the Woman’s Committee in 1890 was able to offer the trustees the sum of $100,000, providing only that women were admitted to the medical school on the same terms as men. Both President Gilman and William Welch opposed the proviso, but Osler, Kelly, and Dr. Henry Hurd, the new superintendent of the hospital, won them over. In the end the trustees voted to accept the offer, and soon afterwards Welch retracted his initial opposition.

One hundred thousand dollars was a good start, but it was still far from the five hundred thousand dollars actually needed to open the school, so the Woman’s Committee went back to work. It was only the generous contribution of an additional three hundred thousand dollars from Mary Garrett during Christmas of 1892 that finally enabled the school to begin preparations for its first class the following year. In retrosepct the school owes its existence as much to Mary Garrett as it does to Johns Hopkins himself.

Along with her second donation, Mary Garrett made the demand that the school maintain the highest possible entrance requirements. Embarrassed by her attempt to bind them too closely to what they feared was an impractical goal, Welch and Gilman objected. Although they believed in the abstract principle that entering medical students should be college graduates, they worried that such a requirement would effectively bar eligible candidates. Garrett, however, would not budge, and in the end she forced the innovators at Hopkins to live up to their own high standards. The result was that Johns Hopkins Medical School became the first in America to require a bachelor’s degree for admission. The significance of the decision for the future of medical education can be at least partially summed up by recalling William Osler’s puckish remark to Welch. “Welch,” he admitted, “we are lucky to get in as professors, for I am sure that neither you nor I could ever get in as students.”⁶²

One indirect result of the admission of women to Johns Hopkins was that, with the exception of the Woman’s Medical College of Pennsylvania, the women’s medical colleges closed their doors one by one. Plagued by mounting financial burdens engendered by the costs of medical education in a new scientific age, and genuinely excited and hopeful about opportunities at quality institutions like Hopkins, female medical educators optimistically predicted women’s greater integration into the profession.⁶³

Coeducation, however, would ultimately prove disappointing. For many reasons, including strong cultural resistance to career women in general, the contradictions in their own ideology, and various and subtle forms of institutional discrimination, female enrollments at coeducational institutions remained scattered and generally scanty in the twentieth century. What is more, women at these schools found themselves isolated from the experience of a self-supporting and self-directed female community, something that the women’s colleges, despite their handicaps, had managed to provide. Medical professionalism and medical education remained unquestionably dominated by men. Indeed one wonders, given female educators’ awareness of the extreme sex-role stereotyping of their culture, how they could have ever expected otherwise?

Equally puzzling is the tenacity with which women physicians clung to the belief that women could be educated to play a special and compensatory role in medicine at coeducational institutions, where they would inevitably be outnumbered. That women physicians held to this conviction suggests the degree to which some of them were still committed to elaborate cultural and biological explanations of gender differences. Even at the end of the century most still found themselves in agreement with Elizabeth Blackwell when she mused to her friend Barbara Bodichon about the role of women physicians:

Hardly welcomed into the profession, women entered medicine in spite of male opposition. They did so by founding creditable and occasionally outstanding medical schools in the nineteenth century. Still they could not integrate themselves as a significant group into the medical mainstream. Always suspicious of the rewards of separate institutions, they viewed them as temporary expedients, and in the process overlooked the dangerous pitfalls of coeducation. Their belief in woman’s special role in medicine and their gnawing worry that all alone, women simply could not train themselves to be good doctors led them to undervalue the enormous potential benefits of separate professional schools in a culture where extreme sex stereotyping was prevalent. Though the women’s institutions had proved that females could be competent, even outstanding physicians, American society was not prepared to come to grips with these achievements. Although successful in the narrow sense, the movement to educate women in medicine in the nineteenth century failed to alter significantly timeworn beliefs about the role of women in the professions.