In the years between 1850 and 1880, the chaotic conditions produced by urbanization and the growth of a profession which had lost the stability of preindustrial smallness, face-to-face personal relationships and an apprenticeship system that reinforced social elitism as it provided access to a generally respectable clientele had worked in favor of women. The profession’s loss of cohesiveness and the intense economic competition of the antebellum period, engendered by the proliferation of low-grade medical schools, the appearance of medical sects, and the abandonment of licensing legislation, eased access to a medical degree for would-be medical practitioners of both sexes. With the erosion of traditional informal mechanisms for controlling who became a physician, the narrow and comparatively homogeneous professional life of the early century was disturbed by the appearance both of mien from more diverse family backgrounds and of women.²

Paradoxically, the temporary lowering of standards served to maintain a professional identity for most healers by conferring on them the title of “doctor.” Such unsettled conditions made it easier for women who wished it to achieve professional status before definitions of professionalism and tracking systems crystallized once more. But as the century closed, and the emergence of scientific medicine boosted physicians’ opportunities to improve their financial and occupational status, a successful medical career came to depend more and more on a network of new or revitalized medical institutions: the medical school, the hospital, the dispensary, and professional societies. Such changes would affect the lives and careers of female medical professionals in numerous ways, and this chapter will attempt to describe the various professional paths that women physicians pursued in a changing medical environment.

In the case of the medical schools, we have already seen that women founded their own schools—a few that were generally of high caliber—while at the same time pressing their right to coeducation. These schools successfully trained women physicians until the increasing costs of medical education forced them to close at the end of the nineteenth century. Although few women physicians had actually preferred separate education, the evidence in the last chapter suggests that women students struggled with the problem of becoming female professionals wherever they went to medical school. Both the women’s schools and the coeducational schools offered them distinct advantages and disadvantages.

Women’s choice of private practice told a similar story. Although conditions changed gradually in the late nineteenth century, it was still possible for the enterprising medical graduate to begin practice directly upon graduation from medical school. But women lacked the needed medical connections and often had a harder time than men. Alida C. Avery, for example, settled in Brooklyn shortly after she completed her studies at the New England Female Medical College. In 1862 she wrote to Caroline Dall of the “discouraging time” she had had office-hunting. “But for the kindness of two friends ...” she confessed, “I should have given up the idea of locating here in utter despair.” And yet, despite Avery’s misgivings, she remained excited at the prospect of private practice. “Tomorrow,” she continued to Dall, “my shingle will appear beside the door, in all its shining glory of black tin & gilt letters. I must own to a little dread of the publicity that involves. I am not quite callous to doing things that people sneer at & say hateful words about; but I shall not think of that if I have work. That is all I ask or pray for at present.” Two months later Avery wrote to Dall, “I have little to tell of myself—am waiting with as little impatience as I can.... The little ... I have had to do have been mostly among friends I knew before coming.”³

Accepted wisdom affirmed that it took women between two and five years to make a private practice self-supporting. The stern and forbidding Marie Zakrzewska, perhaps a bit jaded by the difficulties she experienced as a member of the first generation, warned of “five years of waiting and starvation.” But Emily and Augusta Pope found in their survey of women physicians that most managed modest achievement after only two.⁴ The Alumnae Transactions of the Woman’s Medical College of Pennsylvania recount many success stories. However, one must not minimize the psychological and pecuniary difficulties these women endured. Some even gave up dreams of a medical career entirely. Amy Ames, a 1901 graduate of Philadelphia, practiced for a short time in Camden, New Jersey. When her family suffered financial reverses, however, she could no longer afford the luxury of waiting for patients. She finished her career as a clerk typist in St. Louis, where she was at least guaranteed an income. Anna Angell became the first woman to hold a residency at a New York City Hospital-Mt. Sinai—after graduating from the New York Infirmary in 1874. Then she studied pathology for a year and a half in Germany. Yet her superior training couldn’t protect her from “self distrust and lack of ‘push’.” She never established a successful private practice, and eventually found her place in institutional medicine as a resident at the New York Infant Asylum.⁵

Anita Newcomb McGee enjoyed the advantage of prominent family connections when she graduated from the Columbian University medical department in Washington, D.C. Nevertheless, she spent four disappointing years as a struggling practitioner before she gave it up. Although she continued to be involved in medical and women’s organizations and served as an acting assistant surgeon general of the United States army in charge of screening nurses during the Spanish-American War, McGee never again returned to practice. On the other hand, Rosalie Slaughter Morton, the daughter of an upper-class Southern family and an 1897 graduate of the Woman’s Medical College of Pennsylvania, had little difficulty beginning a flourishing gynecological and surgical practice in the nation’s capital.

Still, Morton understood that her good fortune had in some sense been atypical. Musing several decades later on her financial battle to put herself through medical school she wrote:

Women who chose to practice in urban areas particularly needed patience, courage, and grit. The experience of Bertha Van Hoosen was characteristic. After graduating from the University of Michigan in 1888, she spent four additional years in clinical residencies to gain confidence. During this apprenticeship she had recurring nightmares about failing in private practice. In 1890, after one such episode, she wrote to her sister, “Do you know going into practice is worse than getting married there are so many who make failures of it that you stand hesitating and would give up all plans but for the few glorious examples who stand at the front. One begins to want a new backbone.... I wish I could know right now that I wouldn’t make a failure of it ... I would start without delay.”

Patients came slowly when she finally settled in Chicago, and Van Hoosen was forced to keep “abreast and alive” by teaching anatomy at the Woman’s Medical College of Northwestern University and by giving public health lectures to such groups as the Kindergarten Association. In October of 1892 she wrote to her sister, “I am so anxious to get just one patient in this neighborhood” ; and a week later, discouraged, she confessed, “It is such a long hard pull I often wonder if it will not end in failure.”

But by the spring, her spirits had lifted. “Patients do not bother me much,” she confessed to her parents, “but as long as my money holds out my courage does not flag.... I think I will get some confinement cases next fall and they will help me a good deal.” By the summer Van Hoosen had acquired several new patients, including a female singer from Cincinnati who “always employed a lady physician.” “I think I am getting ahead ...” she ventured, “but it is such slow hard digging.” Gradually her practice grew; by the end of the decade it was an indisputable success. In 1899 she reported proudly, “I am feeling very well and my practice is booming.”⁷

Harriet Belcher’s letters describing her own struggle to survive professionally are a particularly rich source of information. She began to think about setting up practice while she was still in medical school. She first contemplated moving to Cohoes, New Jersey, then Burlington, Vermont, where there was no woman physician and “it is thought a very good opening for one.” She also briefly considered becoming a medical missionary. Finally in 1879, she chose Pawtucket, Rhode Island, three miles from Providence. A fellow student for whom Pawtucket was home had also decided to return there. The student’s preceptress, Dr. Anita Tyng, was doing splendidly in Providence and would help the women get started. Dr. Tyng promised Belcher social and professional introductions, a State Medical Society well disposed to women physicians, and referrals to some of her own patients.⁸

Belcher arrived in Pawtucket in July 1879, with high hopes. Her male colleagues—“far from looking askance at me and my pretentions—welcomed me, spoke of my joining their societies at once, told me to use their names as references.” The following December she was elected to the State Medical Society and the Rhode Island Women’s Club. Everyone expected her to succeed. Belcher particularly enjoyed the community of professional women: she assisted Dr. Tyng several times in surgery, and took over the latter’s practice, often for extended periods of time, when the older woman was away. But her own patients appeared at her door only infrequently, and staying financially afloat became a problem. A year after she arrived she wrote a friend:

In the end Belcher had to leave Pawtucket in order to establish herself to her own satisfaction. In 1882 she moved to Santa Barbara, California, to take over the practice of another female physician who was getting married. In the first month she was already doing better than she had done in Rhode Island. By the end of the year she wrote that her “success” was “assured,” and letters written in the next several years reveal a large and busy practice and a very satisfying social life. ¹⁰

Many women chose to open rural practices or, like Belcher, to pioneer in the Midwest and West. Though the majority of women physicians by the end of the century were concentrated in the urban East and old Northwest, a significant minority pursued less conventional paths. Indeed, their geographical mobility was quite typical of the age. They went everywhere: to the West Coast, to cities and small towns in the Midwest, to rural areas in western Pennsylvania and New York, even to the South. Most often they went alone.

For example, Ida V. Reel, the youngest of eleven children, found a favorite uncle to finance her medical education. After graduating from the Woman’s Medical College in Philadelphia in 1882, she hung out her shingle in Coatesville, Pennsylvania, the only woman physician in the town. She remembered her male colleagues vowing to “run her out of town in three months.” But she stuck it out and eventually learned to take “ribbing” from her fellow professionals and to be a “good sport.” She practiced in Coatesville for sixty-six years, specializing in obstetrics and bone and plastic surgery. At the close of her career she boasted of having delivered three thousand babies, some under the most primitive rural conditions. She never lost a mother. Similarly, Frances A. Rutherford wrote her fellow alumnae in Philadelphia of her arrival in Grand Rapids, Michigan, in 1868: “I was the pioneer. It was a strong thing for a woman to demand recognition as the peer of the old practitioners, but it has been granted.”¹¹’

Anna Jackson Ferris (WMCP, 1874) met with initial opposition as well when she settled in Meriden, Connecticut. Yet fifteen years of successful practice there prompted her to boast in 1894, “I ... have proved to a very conservative people that a woman can practice medicine.” Nannie A. Stevens, a graduate of the Woman’s Medical College in Chicago, left in 1878 to settle in Kansas. First locating in Wichita,, she later moved to Kansas City where she engaged in both surgery and general practice. Soon she was joined by a Philadelphia graduate, Helen T. Graves, whose pastor wrote of her that “she had the confidence of the entire community, and her cheery, sunny face was familiar everywhere in Southwest Kansas City.” Carrie Leiber-Marvin, an 1881 graduate of Chicago, settled in Hope, Idaho. Marvin became a contract-surgeon for the railroad and attended patients within a 200-mile radius. She reported an “ordinary general practice in a mountainous and unsettied country.” Despite the small income, she professed real contentment with her work. So too did Margaret Holland (Chicago, 1873), who wrote from Houston, Texas, that her general practice among women and children earned her a comfortable income and the “respect of the profession,”‘who consulted with her without complaints. ¹²

A decade later, Elizabeth B. Ball, who graduated from the University of Illinois medical department in 1907 and interned at the New England Hospital in Boston for three months thereafter, wrote her mentor there, Sarah M. Taylor, of her successful practice in her home town of Quincy, Illinois. “We have two hospitals, one of which does not admit lady physicians, consequently I am dependent on the other one.” Nevertheless, she explained, “I really felt honored when the directors notified me that my name had been added to the staff. My work is principally in the obstetrical ward. I have been asked to lecture to the nurses in bacteriology and expect to do so in a short time.”¹³

Colorful letters like these from determined women who struck out on their own abound in the alumnae records of the women’s medical colleges in Philadelphia, Chicago, and New York. But perhaps Helen T. Graves’s report to her alma mater written a few years after she left Kansas City to relocate forty-five miles further west in Lawrence best catches the flavor of these women’s experience. “Dear Friends and Fellow-Workers,” she wrote in 1886,

Women physicians new to private practice often utilized public health lecturing as a means of self-support in lean times and as a method of attracting patients. Teaching hygiene courses proved a significant professional activity for women physicians in the nineteenth and early twentieth century, beginning with Elizabeth Blackwell, who offered one of the first such courses on the physical education of girls in the spring of 1852. Blackwell admitted years later that the lectures gave her “my first start in practical medical life.” And so it was with hundreds of women physicians in cities and towns throughout the country who not only took seriously Blackwell’s dictum that they should be the “connecting link” between science and the everyday life of women, but also understood the practical benefits of such public exposure. While they lacked both the professional connections and the easy tolerance from male peers that facilitated hospital appointments leading directly to public acceptance and professional recognition, and until the 1870s were denied membership in most professional societies which were increasingly essential to success as the century came to a close, women physicians found the means to be resourceful in other ways ¹⁵

Early success in private practice was sometimes assured because with some social groups women physicians were in demand. Indeed, while public disapproval often proved discouraging, some women found ready acceptance, especially, but not exclusively among the expanding immigrant populations of the cities. Sara Josephine Baker and a friend graduated from the New York Infirmary in 1898 and, with the usual misgivings and doubts, opened a practice together on New York City’s Upper West Side. Several well-established women doctors that Baker consulted had advised her to go to a small town, predicting five years of real financial hardship and another five years of tenuous existence. But the predictions proved false. “Paradoxically,” Baker recalled, “our only asset was that we were women doctors.... For many years women came to us because we were women and the competition in that line was small.” Like many male physicians, women doctors usually became established with a family first through a successful childbirth. So it was with Baker. “Obstetrics,” she wrote, “have been a godsend to many a young doctor just starting his career.... It is an opening wedge of considerable importance ... when in the natural order of events the father or mother comes down with a cold or some other minor ailment ... you are consulted and have other patients. It was in this way that my practice was built up and became a truly family affair.”¹⁶

In similar fashion, Eliza Mosher and Elizabeth Gerow, graduates of the University of Michigan, enjoyed almost instant success among women and girls when they opened their practice in Poughkeepsie in 1875. Later Mosher moved to Brooklyn and again she and her new partner, Lucy Hall, found themselves being consulted by prominent male physicians wishing to refer patients who preferred to be treated by a woman. In 1887 Mosher wrote proudly to her family:

In some communities, being the “woman’s doctor” carried a considerable amount of informal authority. Pauline Stitt, a physician interviewed in connection with the Women in Medicine Oral History Project, grew up in western New York in a tiny town, Frewsburg, in the 1910s. She remembered that Dr. Jane Lincoln Greeley, rumored to be a cousin of Horace Greeley’s, “practiced regularly and was the most esteemed physician for women.” Greeley did general medicine and gynecology. “It was an era when a lady found it easier to go to a woman,” Stitt recalled. Greeley was “called the doyenne, the dean, of physicians in Chatauqua County.”

Besides private practice, a career option that opened to women in the last third of the nineteenth century was institutional work. Not surprisingly, women were particularly happy to take such positions, though the work carried low professional status and was often scorned by the more ambitious male physicians favoring private practice. D. W. Cathell, M.D., in his widely read book The Physician Himself, And Things That Concern His Reputation and Success, warned the enterprising that offices such as “vaccine physician, coroner, city dispensary physician, sanitary inspector, etc.” tended to “dwarf one’s ultimate progress” by creating a “low grade reputation” that was hard to outlive. Even “permanent physician or assistant physician to hospitals, infirmaries, lunatic asylums, dispensaries, almshouses, reformatory or penal institutions” should be avoided, according to Cathell, since they looked to many people “like a confession of impecuniosity or inferiority.”¹⁹ Uncertain of the rewards of private practice, women were often attracted by the security of such appointments, and the opportunities they afforded to gain expertise.

One of the earliest types of institutional work was employment in a water-cure establishment, something akin to today’s spa. Although many of these health resorts were originally founded by sectarian physicians, regular physicians too understood the practical and therapeutic benefits of sanitarium work. Cordelia Greene, we remember, attended regular institutions—the Woman’s Medical College of Pennsylvania and Cleveland Medical College (Western Reserve). Greene’s interest in sanitarium work was shared by many women physicians of her generation. Samantha Nivison (WMCP, 1855), Angenette Hunt (WMCP, 1852), Fanny Hurd Brown (University of Michigan, 1891), Rachel Brooks Gleason (Central Medical College, Syracuse, 1850), and several others preferred practicing medicine in this setting. Because sectarian institutions had proved initially far more receptive both to hydropathic precepts and to the idea of women in medicine, some of the earliest female water-cure physicians were irregulars. As the century wore on, however, new opportunities for study appeared with the founding of the regular women’s medical schools and the admission of women to some of the regular state schools. By the end of the century, a far smaller proportion of women physicians practiced sectarian medicine, and most water-cure physicians had a regular degree.

The relationship between middle-class women and the female water-cure physician had significant cultural dimensions, implying a great deal about social relations and gender in Victorian America. Chapter 2 chronicled the rise of female health as a feminist issue in the nineteenth century, and described how the rituals of female invalidism and its treatment bound women together through companionship, mutual concern, and consolation.²⁰ The water cure provided one locus in which such bonds between women could be acted out. Women suffering from the physical and psychological debilities of nineteenth century marriage, sexuality, and child rearing flocked to these sanitariums to share their troubles with other women. Here they cared for each other’s illnesses, expressed affection for one another, established and renewed ties of friendship and intimacy. Superintending the entire process was the woman physician—strong, wise, motherly, sympathetic. Compassionate yet firm, she had listened to the “heart-histories” of hundreds of women, and she offered the wisdom of science as a panacea .²¹ Her prescriptions included physiological knowledge, healthy diet and dress, sensible exercise and, almost as often, meaningful and interesting work. She preached an end to the frivolity and ornamentalism which haunted the lives of nineteenth-century middle-class women and made them sick, and the feminist implications of her entreaties were often not far below the surface. It is no wonder that many water-cure establishments were run by husband-and-wife or father-daughter teams, or that male proprietors eagerly sought women physicians to handle their female clientele. The names of well-known nineteenth-century feminists appeared often on the patient rolls of such institutions. ²²

A more modern type of institutional work became available to women for the first time in the 1880s: resident positions at many state reformatories and asylums. Nearly two hundred women physicians served in this capacity in the last three decades of the nineteenth century.²³ In the beginning, a handful of progressive hospital superintendents discovered that women doctors’ services were extremely beneficial to insane women patients, who often were likely to respond sexually to male physicians. Doctors like Merrick Bemis of the Worcester Asylum in Massachusetts, the man who first hired Dr. Mary Stinson in 1869 as assistant physician in the department for women, understood that because women doctors’ professional options were limited, they were easy to hire and easy to retain. To be sure, most hospital administrators remained staunchly opposed to the innovation, but after a brief struggle and significant pressure from feminists, the employment of women doctors in public institutions eventually came to be required by statute in several states. In 1900 Calista V. Luther, herself a psychiatrist, reported to the alumnae of the Woman’s Medical College of Pennsylvania that out of 133 public institutions for the insane, thirtyeight—a little over one-fourth-employed women physicians. These positions were distributed among seventeen states in the East and the Midwest.²⁴

Asylum work was attractive for the female medical neophyte because it offered an opportunity to treat a variety of physical and mental ailments, provided economic security in the form of room and board, and even presented a chance to make contacts or to build a reputation in the neighboring community which would later on ease the transition to private practice. Upon leaving institutional service, men and women established practices in nearby areas. The occasion for social intercourse with other physicians was perhaps a less anticipated by-product for these institutionallyemployed women doctors: but, according to Constance McGovern, at least two dozen of them married men who served with them on medical staffs ²⁵

Women physicians pressed nthusiastically for the chance to do asylum work, both for the clinical experience it provided and because of their increasing interest in psychiatry. Characteristically, many of them believed that women had a unique contribution to make to the care of the insane. “The field of psychiatric work calls loudly for an invasion by the woman physician,” Louise G. Rabinovitch told the alumnae association of the Philadelphia Woman’s Medical College in 1903. “I doubt whether there is any other branch of medicine that can less afford to dispense with her services. Those of you who are acquainted with the history of the insane asylums previous to the advent of the woman physician into them ... probably appreciate but too well the crying necessity for women’s more active participation in this work.”²⁶

Though they did provide some women with invaluable clinical experience, institutional appointments in psychiatric hospitals did not fulfill their promise as an avenue of professional advancement. A strong undercurrent of skepticism about women physicians pervaded the fledgling psychiatric profession and thus blocked avenues to achievement. Women were not welcomed at the meetings of the American Psychiatric Association until the turn of the century. Although by that time the percentage of women physicians choosing to specialize in psychiatry was on the increase and would continue to rise in the twentieth century, most found the unequal treatment they received at state institutions less desirable than private practice. Regularly passed over for promotion, systematically paid lower salaries, and frequently forced to confront an unsupportive superintendent, women in psychiatric hospitals often found the plethora of dead-end positions a real limitation on their success in this new specialty. ²⁷

Women’s schools and colleges, and later on, the large coeducational universities, also provided institutional employment for women physicians in the last third of the nineteenth century. When E. H. Clarke argued that higher education impaired the health of adolescent girls, he may have unwittingly helped to create more jobs for women doctors. The response of many educators to Clarke’s dire predictions was not to bar women from college, but to hire female resident physicians to monitor the physical well-being of women students and teach hygiene and physical culture. As Dr. Grace Wolcott explained to the Woman’s Medical College of Pennsylvania alumnae in 1892, “We constantly receive application for young women graduates in medicine who would be capable of taking charge intelligently of the course on physical culture in girls schools or colleges. Such a position usually involves also instruction in elementary physiology.”²⁸ School positions, like asylum work, offered varied advantages in terms of security and income for those not willing to risk the hardships of private practice.

By the end of the nineteenth century, the more progressive coeducational universities had joined in the clamor for a resident physician for women students. And yet here, too, professional advancement was both shaped and constrained by gender.

The story of Eliza Mosher’s tenure at the University of Michigan is illustrative of women physicians’ experience. Because she lived a full and busy life in private practice in Brooklyn, Mosher felt only cautiously receptive in 1895 when President James B. Angell of the University of Michigan asked her to Ann Arbor to become the school’s first dean of women. Although most coeducational institutions strictly supervised the comings and goings of their women students, Michigan until the 1890s had boasted of a relatively permissive atmosphere that implicitly trusted much to the women themselves. Pressures from parents, alumnae, and faculty, and the desire of the women students for their own gymnasium finally led Angell in 1895 to conclude that the ideal solution would be to hire a woman physician who could supervise health, direct physical education, and offer counsel and guidance on personal problems. Angell had been impressed with Mosher when she studied at Michigan’s medical school, and he wanted her for the job.²⁹

But negotiations dragged on for over a year. Mosher, justly proud of her medical degree, assumed as a matter of course that she would have an appointment in the medical school, where she could teach gynecology. The reluctance of the dean of the medical department, Dr. Victor Vaughan, to appoint a woman to the medical faculty, despite Michigan’s liberal record on women students, proved typical of the disadvantages to women of medical coeducation. Even where women gained admittance to schools as students, female faculty consistently despaired of prestigious medical appointments. The position of resident physician all too frequently became the only one available to women doctors in universities. Such appointments carried neither the status nor the power of a regular place in the medical school.³⁰

In the end, the title Dean of Women and Professor of Hygiene in the Literary Department was agreed upon, still making Mosher the first woman faculty member at Michigan. She also served as resident physician to women and director of physical education. Feminists hailed the appointment as a breakthrough, despite Mosher’s inability to get her way with the medical school. ³¹

Mosher considered the professorship of hygiene an important part of her job. She taught not only personal hygiene and home economics to young men and women, but sanitation, preventive medicine, and public health. Her courses anticipated much of the thinking in public health and preventive medicine which became standard fare in the progressive era. They also were the precursors of later courses in euthenics and home economics designed specifically to professionalize homemaking and make it a science.³² Indeed, women physicians with positions like Mosher’s are not given the credit they deserve for being pioneers in the field of public health education and home economics.

Lilian Welsh, a graduate of the Woman’s Medical College of Pennsylvania who became Professor of physiology and physical training at Goucher College in 1894, accurately described the status of preventive medicine at the time:

Undaunted, Mosher established a rigid system of preventive medicine and physical education for Michigan’s coeds. She personally examined all the girls, measured and advised them as to corrective exercises, reviving an elaborate system of record-keeping which she and her partner Lucy Hall had developed in the 1880s when they had worked part-time at Vassar. One of her most dramatic ccomplishments was the vaccination of over three hundred girls for smallpox early in the first year. ³⁴

Ironically, Mosher never received more than a lukewarm reception from the women students. Contemporary reports indicate that males took to her much more easily. An imposing physical presence-nearly six feet tall, large-boned and straight-backed with a crown of white hair and steel rimmed spectacles—her missionary zeal seemed too dictatorial to some. She had strong opinions about proper posture, healthful dress, and physical education for women. Remembered one student: “She marched us around like a regiment of soldiers. It was useless to say one word against physical education. Dr. Mosher called anyone who didn’t like it ‘just plain lazy.’ ”³⁵

Lilian Welsh faced similar opposition at Goucher and dryly attributed it to the desire to preserve personal liberty—“that is the liberty of the individual to enjoy poor health unmolested.” But other students were offended by Mosher’s no-nonsense approach to physiological instruction and her connection of such instruction with an “old-fashioned” brand of militant feminism. She had sewed for herself out of brightly colored silk a whole set of models of internal organs, and these she made use of constantly in her classes, draping them over her body for visual effect. Commented one student, “Her lectures on anatomy and physiology were horrible to us. She’d try on her silk organs like a dress and talk about them freely. It made us shudder. ³⁶

Another area where Mosher occasionally trod on toes was in her belief that the University should act “in loco parentis” by closely supervising the coeds. Rules for social conduct appeared suddenly, and the new dean enforced them without mercy. Girls who traveled to and from Ann Arbor were for the first time required to do so by day or by pullman sleeper overnight. One freshman who sat up in a coach all night on a trip home was promptly suspended despite protests from her mother. When on appeal Angell upheld the dean’s decision, the angry young lady left Ann Arbor for more liberal quarters. Surely many of these Old Guard women physicians harbored behavioral expectations that inevitably clashed with those of their charges—a new generation of women with less puritanical inclinations.³⁷

The women’s medical schools also provided teaching positions for outstanding medical women. Especially in Chicago, Philadelphia, and New York, female faculty became respected members of the medical community, enjoying because of their position a unique and cordial relationship with the more liberal male members of the profession. Hospital work connected with these schools afforded an opportunity to do clinical research. But, most important, these separate female institutions provided a visible professional platform from which women physicians could do creative medical work while giving them the power to strengthen networks among medical women—networks that contributed so much to the viability of the movement to train women in medicine. Historians of women are just beginning to describe and assess the importance of the connection between strong, separate female institutions and the success of feminist goals more generally ³⁸The women’s schools became a training ground for faculty as well as for students, and their diminished number in the twentieth century severely handicapped women’s advances in medical academia.

When the New York Infirmary closed its doors in 1900 to merge with Cornell, for example, a competent faculty of women was displaced, for Cornell refused to hire women. In her closing address to students and faculty, Dean Emily Blackwell acknowledged the situation with sadness, admitting that the women’s schools had been the only institutions willing to “offer advanced positions to women who will work for them.” There was nothing the friends of the Infirmary college regretted more in closing the school, she admitted, “than the fact that it cut short, temporarily at least, the teaching career of a group of capable and rising young women teachers.”³⁹ Unfortunately, Blackwell’s hope that the situation would be only temporary proved to be merely wishful thinking.

The reluctance of coeducational medical schools to hire women faculty also hampered women’s careers in research. In the 1880s and 1890s, a life of full-time research at a medical school or a research institute was still primarily a thing of the future, but women, of course, endured the additional disadvantage of gender. There were dozens of women attracted to bacteriology at the end of the century, and many managed to train abroad. Edith Cadwallader (WMCP, 1900) studied in Vienna with Wechselbaum and Landsteiner. Mary Sherwood, a graduate of the University of Zurich, spent several years working in Kleb’s laboratory there, where her close friend Lilian Welsh (WMCP, 1889), also hoping to do research, had joined her. But when the two women returned to the United States after a year of studying pathology together they were forced by circumstances to change their direction. Although they maintained informal connections with William Welch’s laboratory at Johns Hopkins, there could be no position there for either of them, and both became resident physicians, at Bryn Mawr School and Goucher College, respectively.

Only a handful of women had more success in achieving their research goals. Martha Wollstein did private work in pathology for several hospitals in New York after her graduation from the New York Infirmary, and she ultimately won an appointment at the Rockefeller Institute of Medical Research, founded in 1904. With Mary Putnam Jacobi’s help, Anna Wessel Williams managed to obtain a position as a full-time staff member working with William Hallock Park, an early exponent of applied biology, at the newly established diagnostic laboratory of the New York City Department of Health. It was Williams who isolated a strain of the diptheria baccillus in 1894 that subsequently became known throughout the world as Park-Williams #8, or the Park strain. William’s discovery significantly facilitated antitoxin production and allowed the city to launch its first successful antidiptheria campaign. Although Park was on vacation at the time of the isolation, much of the credit for the discovery characteristically fell to him because of his position as laboratory directors. ⁴⁰

The most prominent of the early women physicians in research, however, was Florence Sabin. A classmate of Dorothy Reed Mendenhall’s at Johns Hopkins in the 1890s, Sabin attracted the attention of the great anatomist Franklin P. Mall, probably the most outstanding scientist on the Hopkins faculty. She became his protege, and under his guidance constructed the first three-dimensional model of the brain stem of a newborn. This early work, completed while she was still a medical student, was soon published as An Atlas of the Medulla and Midbrain. ⁴¹

Although her early promise made her a likely candidate for a teaching position, the medical school proved reluctant to welcome a woman to its faculty. A glance at the Johns Hopkins faculty in the next decades indicates that, despite its commitment to the acceptance of women as students, the school remained as recalcitrant on the question of female faculty as institutions elsewhere in the country. Such stubborn discrimination rankled many women physicians, who understood that it would prove a major stumbling block to their professional advancement in the twentieth century. ⁴² In Chicago Alice Hamilton, for example, remembered with irony her early association at the Memorial Institute for Infectious Diseases with the brilliant bacteriologist Ruth Tunnicliffe. At the turn of the century, Tunnicliffe had already achieved distinction, but the limitations imposed on her career opportunities because of her gender did not escape Hamilton’s notice:

More fortunate, perhaps, than Tunnicliffe, Florence Sabin did not have to brook sex barriers for long. When the reluctance of the Hopkins faculty to hire her became known to the Baltimore feminist community, they secured her a fellowship to continue her laboratory work. A year later her outstanding ability could no longer be overlooked, and she became the first woman to teach at Hopkins, as an assistant in the Department of Anatomy.

For the next twenty-three years, Sabin distinguished herself there both as a scientific investigator in embryology and histology and as an inspiring mentor. Throughout her career she emphasized a philosophy of self-education and student research that she had learned from Mall. “Books,” she often told her students, “are merely records of what other people have thought and observed. The material is a far safer guide.”⁴⁴ Like Mall, Sabin developed a keen eye for the gifted student, and she inspired many to careers in research. Although she was always supportive in her contacts with other women physicians, the young scientists she worked with most closely were all men. She never managed to attract directly a woman to become her protege.⁴⁵

Sabin’s lack of female followers remains one indication that the branch of medicine she chose proved particularly resistent to women. But perhaps another more subtle impediment lay in the image of herself which she projected. One young male protege remembered her in a histology class in 1909: “Dressed very plainly, usually with a plain brown skirt of tweed,” he recalled. “No cosmetics. Neat but not ostentatious. After all, business was business ”⁴⁶

It was not that Sabin was unfeminine. Most descriptions of her take note of her qualities of sympathetic understanding, maternal gentleness, and humanity. Yet one wonders what kind of role model she presented to a younger generation of women physicians whom she herself regretted were no longer “serious minded” enough, but were just “nice girls.” For an increasing number of educated women in the twentieth century seeking to balance marriage and a career, Sabin, who essentially had chosen work over marriage, may have been able to provide little in the way of encouragement or advice. Indeed, when the daughter of a friend expressed interest in becoming a doctor, Sabin advised against it, arguing that the girl was too pretty and would drop out of school after a few years to get married. ⁴⁷

Though Sabin was in a position to notice the disappointing effects of sex bias, she remained reluctant to recognize discrimination, even when it affected her own career. In 1917 the death of Franklin Mall forced Hopkins to seek a new chairperson for the anatomy department. To the shock of almost everyone, Sabin was passed over for promotion in favor of Lewis Weed, one of her own former students. Friends immediately joined with Baltimore feminists to protest. Hastily Sabin was appointed professor of histology, the first full-time woman professor on the faculty. Although her biographer suggests that she reacted to the incident with dismay and disappointment, she lodged no public complaint and toyally remained at Hopkins for another seven years. Only when Simon Flexner enticed her to join the Rockefeller Institute as its first woman fellow in 1925, did she leave her beloved alma mater.⁴⁸

Although she remained unwilling to make herself an “issue,” Sabin practiced her own brand of quiet feminism. Living among Baltimore’s strong and militant feminist network, which included several women linked to the medical community, kept her aware of women’s concerns. There was, of course, the original Woman’s Committee under the leadership of M. Carey Thomas. In addition, Sabin developed warm and lasting friendships with two “faculty wives”-Mabel Mall and Edith Hooker. Both women had met their husbands while attending the medical school. While each abandoned medicine and settled down to raise large families, neither of them surrendered their intellectual acuity or their active interest in social issues. Both ardently supported suffrage for women; indeed, Edith Hooker rose to prominence as chairwoman of the Woman’s Party. Her affluent and genteel home became a gathering place for feminists. Mall and Hooker, along with Sabin’s occasional good-natured aid addressing envelopes, published the Maryland Suffrage News, a local feminist bulletin.⁴⁹

Sabin also cultivated an enduring friendship with Lilian Welsh and Mary Sherwood. The three physicians often met for lunch on Saturday afternoons to discuss medical research and women’s issues. Sabin knew that Welsh’s original desire had been to do medical research, and remarked with admiration that Welsh “got the most intense enjoyment out of seeing younger women get the opportunities she had lacked.” Sabin admired Welsh’s lack of bitterness. Such an attitude tells much about Sabin herself. Despite her quiet devotion to women’s rights, Sabin often expressed the belief that “it matters little whether men or women have the more brains: all we women need to do to exert our proper influence is use all the brains we have”⁵⁰

Sabin’s career suggests that she persistently followed her own advice. Her brilliance, combined with a compliant and reserved personality marked by personal dignity and maternal generosity, won her an honored position in the male world of twentieth-century scientific medicine. But her success was not typical of the majority of her medical sisters, who found pathways to influential places in the medical elite closed to them. ⁵¹

By the end of the nineteenth century a successful medical career came to depend increasingly on connection with medical institutions—hospitals, dispensaries, schools, professional societies. The hospital had already emerged both as a central institution for the care of the sick and a major center for the education of physicians. Clinical training there became more and more important for the young doctor wishing to become well established, especially as advances in surgery and medical technology rendered therapeutic skills more complex and more important. Such changes in the delivery of medical care presented a dilemma for the woman physician. She too must move with the times, all the while attempting to do so in a professional and social atmosphere often unwilling to extend to her equality of opportunity.

Hospital appointments, for example, were an early goal of female medical educators. Male students often studied with preceptors who had clinical positions in various hospitals throughout the city, but such contacts were difficult for women to obtain. Efforts were first directed at securing for them the opportunity to attend clinical lectures and surgical operations performed regularly in hospital amphitheaters. The right merely to observe was not always won easily. Although authorities at Blockley Hospital in Philadelphia agreed readily in 1868 to admit students from the Philadelphia woman’s medical college to the general clinics, and Dr. Alfred Stille, the prominent Philadelphia physician who taught there, welcomed the ladies “cordially” a year later when they presented themselves for Saturday morning clinic at Pennsylvania Hospital, a near riot ensued. In spite of the permission granted to the women by the hospital managers, the male students at the Pennsylvania would tolerate no women

In New York Anna Manning Comfort, a student at the homeopathic New York Medical College for Women, recalled similar rude treatment when she and other women students first began attending clinics at Bellevue Hospital in the late 1860s. Yet in other cities, women were accepted without fanfare: Boston City Hospital and Cook County in Chicago both welcomed them quietly in the 1880⁵²

Female medical educators who well understood the new trends in scientific medicine, however, rightly viewed these large clinics as a poor substitute for ward work. Most agreed with Mary Putnam Jacobi’s observation, “To students habituated to the daily visits in the wards of the best European hospitals, this form of clinical instruction, where the patient studied is seen but once, and then at a distance, must be seen as ludicrously inadequate. ”53 Of course male and female students suffered such defects indiscriminately, except that men could more easily remedy their situation by securing clinical residencies at city hospitals or dispensaries. Consequently, female leaders strove to open these competitive appointments to women as well. ⁵³

Such opportunities came slowly, and remained woefully deficient well through the first half of the twentieth century.⁵⁴ Emily Dunning Barringer recalled in her autobiography the disappointment and anger she felt in 1901, when her four years of medical study were drawing to a close and she contemplated the next step after graduation. She felt, she wrote, like a pianist who had practiced long and hard to perfect his technique, only to be told at the last minute that he could not try his skill on the Steinway. “Surely it was illogical,” she complained, “for the medical school to train women physicians equally with men, and then make no adequate arrangements for them to obtain internships.”⁵⁵ Clinical appointments for women at large city hospitals, when they were available at all, were scattered and irregular. In New York City, for example, Dr. Annie Angell and Dr. Josephine Walter, both graduates of the New York Infirmary, won three-year appointments as resident physicians at Mt. Sinai hospital after severe competitive examinations. Yet when Dr. Walter finished her term in 1887, New York City went without a female resident at any of its major hospitals until Barringer, spunky and determined, and backed from behind the scenes by the powerful Mary Putnam Jacobi, wrested an internship at Bellevue Hospital’s downtown branch despite the almost successful efforts of the Commissioner of Hospitals to block the appointment of a woman.⁵⁶ .

Similarly, Boston’s regular hospitals barred women from clinical positions until World War I. That even then hospital internships remained a problem is clear from the correspondence from 1916 and 1920 between two Johns Hopkins students, Ernestine Howard and Martha May Eliot, and their prominent Boston parents. Internships for women were frequently the subject of discussion. In 1916 Eliot burst out to her mother after witnessing her first surgical operation:

In Philadelphia women competed for internships at Blockley after 1883 and received twelve such appointments in the next decade. Chicago proved the most liberal in this regard, however. Cook County opened its examinations to women in 1877, and by 1889 four hospitals in the city were willing to accept women interns and residents.⁵⁸

Securing an appointment, of course, did not necessarily imply acceptance by colleagues or staff. Emily Dunning Barringer weathered only with heroic determination the most malicious hazing from four “headstrong” and “ruthless” male interns who were willing to stage a “battle royal” to “get me off the staff.”⁵⁹ And even at Johns Hopkins, whose charter bound the administration to a nondiscriminatory policy, women occasionally had trouble. One memorable incident regarded the appointment of Florence Sabin and Dorothy Reed Mendenhall as interns in 1900. Because of Hopkins’s commitment to equal treatment, outstanding women had won hospital internships from the beginning, but there had never been more than one woman on a service at a time. When the matter of hospital appointments arose that year, however, Sabin stood third in the class, while Mendenhall ranked fourth. Although there were four internships each in surgery, medicine, and gynecology, the most coveted positions were those under Dr. Osier in medicine. Because the top ranking student’s health barred him from vigorous work and the second in the class chose surgery, nothing stood in the way of both Sabin and Mendenhall’s right to choose medicine.

Faced with the possibility of two women interns on the medical service, William Welch, who had been a warm and generous mentor to Mendenhall, summoned her to his office to explain “that there was a serious embarrassment over the fact that Florence Sabin and I were both honor students and of course there could never be more than one woman interne and would I like to take surgery or gynecology as he thought there could not possibly be two women in medicine. This would necessitate one of us working the colored wards—men and women—and this seemed unwise.” “He was kindness itself,” recalled Mendenhall, “really solicitous of my future and desirous of helping me to make the decision.”

But Mendenhall stood firm. She wanted medicine. Although Sabin wavered, Mendenhall refused to let her friend buckle under. In the end, Welch and Osler, honorable men both, reluctantly backed two women.

Mendenhall’s private victory was not won without cost, however. She later incurred the wrath of several men near the top of the class who felt cheated out of their “rightful” positions. And when she and Sabin arrived that September to take up their duties, they were harassed by the hospital superintendant, Dr. Henry M. Hurd, who made an ugly scene and accused them of “abnormal sex interests,” for their willingness to work on the male colored ward.⁶⁰

More numerous and slightly less competitive, dispensary appointments were easier for women to secure than hospital residencies. Mary Putnam Jacobi listed fourteen New York City dispensary positions held by women in the year 1891 alone. But dispensaries were a relatively short-lived institution for the delivery of health care. Appearing in the 1880s and 1890s, they were already in decline by the 1920s, and with their demise women lost a significant source of clinical experience. ⁶¹

Besides pressing persistently for equal treatment at established institutions, women physicians moved unilaterally to solve their problems of inadequate postgraduate training in two additional ways. For those who could afford it, work in Europe became extremely common, just as it was for the male medical elite. Ironically, the great medical centers in France, Germany, Switzerland, and Great Britain proved quite cordial to women in the last third of the nineteenth century. Hundreds of women physicians took advantage of European opportunities. Most of the attending staff at the New England Hospital for Women and Children—including Susan Dimock, Lucy Sewall, Helen Morton, Elizabeth Keller, Fanny Berlin, Emma Call, and Mary A. Smith—spent at least a year abroad. Mary Putnam Jacobi sought an additional medical degree from the prestigious tcole de Medicine in Paris. At the Woman’s Medical College of Pennsylvania, Emmeline Cleveland, Anna Broomall, and Frances Emily White were only a few of the female faculty members who finished their clinical training outside of the United States. Others, like Lillian Welsh (WMCP, 1889), Anna Wessel Williams (New York Infirmary, 1891), and Anna A. Angell (New York Infirmary, 1871) were drawn to the great pathological laboratories in Germany, although opportunities in laboratory research did not open up for women until the very end of the century.⁶²

Women physicians partially solved their need for clinical experience by founding their own hospitals and dispensaries. Although the dispensary as a medical institution was relatively short-lived, many of the hospitals proved remarkably hardy in the transition from nineteenth-century to twentieth-century scientific medicine: the New York Infirmary on Manhattan’s Lower East Side, Boston’s New England Hospital for Women and Children, Children’s Hospital in San Francisco, the Mary H. Thompson Hospital in Chicago, Northwestern Hospital for Women and Children in Minneapolis, the Sara Mayo Hospital in New Orleans. More transient, but equally important to their professional success, dispensaries run by groups of women physicians, like Baltimore’s Evening Dispensary for Working Women and Girls, appeared and disappeared in rhythmic succession on the medical landscape in almost every city where there were more than a handful of women doctors. Together these institutions brought several generations of women physicians to professional maturity. Here was an opportunity to work with women physicians often trained in Europe; here were women physicians and surgeons providing competent and thoroughly professional role models to young women still deprived of a clear sense of their place in medicine.

A young intern at the New England Hospital in the 1880s recalled decades later that the atmosphere there was one of commitment and competence. Women were “well aware” she remembered, “that they were under the critical eye of contemporary men, and, therefore, must excel in whatever they do.” Consequently, life was “indeed serious” for the unseasoned women who came under the “watchful” eye of these early pioneers. “If in an unguarded moment,” recalled Dr. Kate Campbell Hurd-Mead,

At the New York Infirmary, one of the great attractions was the opportunity to work with Mary Putnam Jacobi. “Dr. Jacobi,” recalled one of her favorite students, “had an amazing fund of general medical knowledge and was said to be the most widely read medical person in New York City at that time.” Although her prolific medical writings were well known and admired, she also excelled as a clinician. “Her knowledge of diagnosis and differential diagnosis was profound,” remembered Emily Dunning Barringer, “and based on fundamental understanding of the basic sciences back of medicine. She was a hard taskmaster; there were no short cuts in establishing a diagnosis.... What could have been more valuable for an impressionable young doctor just starting out, than to find herself in this atmosphere of truly great scientific accomplishment and to have all her standards of medical procedure crystallized day by day?”⁶⁴

The female clinicians in these hospitals excelled particularly in obstetrics and gynecological surgery. Young women interns who came of age professionally at the end of the nineteenth century and had the opportunity to observe the changes wrought by scientific medicine, believed that women doctors trained in obstetrics in this period received instruction superior to most men. Of her apprenticeship to Helen Morton at the New England Hospital Eliza Mosher wrote:

In Philadelphia Anna E. Broomall, who spent several years studying in Germany, dominated the wards of the Woman’s Hospital when she succeeded Emmeline Cleveland in the chair of obstetrics upon the latter’s death in 1879. Here she made several innovations, establishing a separate maternity hospital connected with the college and emphasizing prenatal and postnatal care well before it became accepted by the majority of physicians. Always the bold clinician, Broomall was one of the first physicians to recommend routine episiotomy in obstetrical cases.

Though she was an expert surgeon as well, the Board of Directors of the Woman’s Hospital had typically decreed that a male surgeon must attend Broomall in the amphitheater for all laporatomies. After a few such instances of monitoring, her male colleagues refused to continue the humiliation on the grounds that she was more skillful than most of them. Of Broomall’s striking expertise one of her students wrote: “Of one thing I am confident, Dr. Broomall was far ahead of her time in teaching obstetrics, and her students were greatly superior in mechanical skill to the young men who graduated from the universities during the eighties and nineties. ”⁶⁶

Some of these women pioneers managed to retain a personal warmth in their dealings with younger women, despite the crustiness that their hard-won accomplishments had demanded of them. Though students remembered Anna Broomall as imposing, colleagues also recalled her commitment to family relationships as quite “astonishing.” Similarly, Mary Bennett Ritter, a graduate of Stanford’s Cooper Medical College in California in 1886, discovered Charlotte Blake Brown, the founder and dominant figure at San Francisco’s Children’s Hospital, to be warm, “beautiful,” and “always like a mother to me.” Ritter interned at Children’s in 1887. Brown’s personable style, Ritter remembered, did not deter her mentor from developing a reputation as a remarkably innovative and highly respected professional. It was she, for example, who diagnosed Ritter’s chronic ill health as septaecemia, and in a bold and still-rare surgical move, cured her by removing an intestinal abcess which the younger woman had endured unknowingly since the age of twelve. Brown performed the first ovariotomy by a woman in the West, and was particularly popular among San Francisco’s Chinese population, who preferred that their women be treated by women. ⁶⁷

Indeed, the unique atmosphere of the women’s hospitals often elicited genuine enthusiasm from open-minded men. Professor James Chadwick of Harvard Medical School publicly praised the New England Hospital for its special atmosphere in an article published in the Boston Evening Transcript in 1882: “There are probably few hospitals in the country,” he wrote,

Like the hospitals, the dispensaries founded by women physicians in the late nineteenth century also had a peculiar flavor of their own. As did all dispensaries, they catered to the working class, but treated primarily the women and children of the immigrant and native-born poor. The first such dispensary was that connected with the New York Infirmary, which ran an extensive outpractice on the Lower East Side. The work included home visits by nurses or interns. Although insufficient funding and sparse personnel cramped the dispensary’s operations between 1853 and 1879, work in the outpatient department became a requirement of the medical curriculum in 1889, and funding was then put on a firmer basis. Annie Sturges Daniel took over direction of the Dispensary in 1879 when she graduated from the Infirmary and for the next sixty years charted its course. Daniel was an impressive figure, well respected by students and beloved by the immigrant poor. Her radical outspokenness on prison reform and on the elimination of tenement houses and sweatshops, for example, earned her the nickname “The Angel of the Lower East Side.⁶⁹

Dispensary work often shocked and dismayed young women physicians who, despite their own courageous willingness to stray from prescribed paths, generally viewed life from the solid perspective of the middle class. As Daniel herself admitted, “The degree of wretchedness, filth, of utter degradation in the abodes of many of the poor would be inconceivable to the majority of women in comfortable circumstances.” While working in the outpatient dispensary of the New England Hospital, Harriet Belcher wrote of being called to a case of criminal abortion in a brothel. “I did not want to be mixed up in any such affair,” she wrote her friend Eliza. “After getting her out of immediate danger you may imagine I informed them that they could call in another physician. I am learning many lessons besides professional ones, and not the least is to be more thankful each day I live for the happy protected life I have had.”⁷⁰

Some women physicians never got used to the squalor. “The work was often thrilling,” wrote Anna Wessel Williams of her year as Daniel’s assistant at the Infirmary’s dispensary, “but mostly disappointing and depressing. Such a mass of dirty, irresponsible, non-responding people I met that I came to the conclusion that they were not ready for what we were able to give them. Crowded back tenements, dark broken stairs, no fire, with mother and children in bed to keep warm, street beggars with plenty in their tenement homes—these and more were the impossible situations I was constantly meeting. How dissatisfied it all made met ⁷¹

For others, however, work in the slums could be radicalizing. Women physicians clearly performed a form of social work years before it became fashionable or professionalized. Daniels has often been cited for her innovative and groundbreaking programs. “The medical problems which present themselves to the physicians are so closely connected with the social problems,” she wrote in 1891, “that it is impossible to study one alone. The people are sick because of insufficient food and clothing and unsanitary surroundings, and these conditions exist because the people are poor. They are often poor because they have no work.” Consequently, the dispensary often provided food, fuel, clothing, and rent, made loans, aided in securing work, and even helped some of its patients to emigrate west. For children Christmas trees and Thanksgiving dinners were the rule, and many young people were sent to the country in the summer for two-week outings.⁷²

In Philadelphia four alumnae of the Woman’s Medical CollegeMarie B. Werner, Ida Richardson, Marie K. Formad, and Calista V. Luther—founded another type of outpractice, “The Medical Aid Society for Self-Supporting Women,” an evening dispensary located “in the central part of the city, so as to make it possible for those employed during the day to obtain advice and treatment.” Most dispensaries of this type charged a nominal fee “to avoid the pauperizing effect” of outright charity. ⁷³

In Boston the Trinity Dispensary grew in 1885 out of the Girls Industrial Club of the Church of the Trinity, which had invited several of the city’s women doctors to lecture on hygiene and advise on health problems. Before long Drs. Grace Wolcott and Lena V. Ingraham had expanded the staff to include six physicians, some of them specialists. Weekly lectures on dress and evening classes in calisthenics added diversity to the dispensary’s program. Keeping evening hours proved particularly successful with all such clinics. “Then we reach,” reported Dr. Ingraham, “a portion of the community that has scarcely been touched before.”⁷⁴

From 1891 to 1910 when the Evening Dispensary for Working Women and Girls in Baltimore closed, it remained yet another exemplary women’s institution which practiced social medicine with compassionate determination. Founded by two graduates of Philadelphia, Kate Campbell Hurd-Mead and Alice Hall, the dispensary was a mutual social service organization between patient and physician, intending to give free care to the needy while affording supervised postgraduate training to young women doctors. Before long several prominent women physicians in Baltimore joined the staff, including Lilian Welsh and Mary Sherwood, while others, like Florence Sabin and Elizabeth Hurdon, a surgical protege of Howard Kelly’s at Johns Hopkins, donated their time.

The dispensary staff gave hundreds of lectures to women and girls on hygiene. It employed the first visiting nurse in Baltimore, and established the city’s first distribution of clean milk to sick babies of the poor. It started the city’s first public bath, made a special study of midwives and birth registration, and became the second institution in Baltimore to organize a social service department under a trained social worker. Finally, its careful study of deaths from tuberculosis for the years 1890 to 1900 helped to inspire the founding of the National Tuberculosis Association ⁷⁵

And yet, despite the substantial and innovative contribution these female-run institutions made, both to the training of women physicians and to health care more generally, tough-minded professionals like Mary Putnam Jacobi never deceived themselves regarding their ultimate value. The small women’s hospitals, concentrating as they did on obstetrics and gynecology, tended toward “specialism,” she wrote, “which, though useful for the patients, is detrimental to the physicians who must find all their training in them.” Equally unnerving to Jacobi was a gnawing fear that “isolated groups of women cannot maintain the same intellectual standards as are established and maintained by men.”⁷⁶

There is some evidence that Jacobi’s worries may have been justified. When the locus of physician education shifted from the medical school to the hospital, the women’s hospitals all experienced institutional crises of one sort or another in addition to the unwanted effects of de facto specialization. Gradually the complex technology and treatment that became the hallmark of modern medicine was concentrated within hospital walls. Indeed, a leading spokesman for scientific medicine regarded the hospital as so essential to the medical school curriculum that, in 1900, he declared in the Journal of the American Medical Association that “to a large extent, the hospital [with all its facilities] is the medical school.”⁷⁷ Women’s hospitals, if they were to serve their purpose as training institutions, needed to be responsive to the professional needs of those who sought to learn-clinical medicine on their wards. But some of these institutions were slow to recognize the increasingly crucial role of the hospital in teaching young doctors, and fell behind in their willingness to provide up-to-date clinical experience to women students and interns.

In Philadelphia, for example, disagreements over giving students actual ward responsibilities arose between the Woman’s Hospital’s Board of Lady Managers, always jealous of the institution’s reputation, and the faculty of the Woman’s Medical College. The tension led the school in 1904 to sever its half-century old ties with the institution and build a new hospital, one more directly under the control of the teaching faculty ⁷⁸The controversy temporarily hampered the quality of clinical education the school could offer.

In Boston ill-feeling over the kind and quality of clinical experience available mounted between attending staff and interns at the New England Hospital for Women and Children in the 1880s and 1890s. Evidence suggests that old-guard physicians under the leadership of Marie Zakrzewska remained insensitive to the professional needs of newly graduated interns. The younger women complained of being treated with disrespect and asked to be trusted with more direct responsibility for patient care. In several written communications in 1883 Zakrzewska repeatedly patronized her charges, declaring that “the main object of the NEH” was to give young women the chance to see women physicians and surgeons in action so “that thereby they may acquire courage and self-reliance, which can never be so completely gained by seeing men acting as physicians and surgeons.”⁷⁹

Zakrzewska did not respond adequately to the interns’ demands, and although the crisis passed temporarily, tempers flared again in 1891. In that year Dr. Bertha Van Hoosen, fresh from the University of Michigan and an additional year of clinical experience at Kalamazoo State Hospital for the Insane, accepted an appointment as resident physician in Boston. But she resigned after several months’ service. Van Hoosen’s letter of resignation suggested numerous changes in the organization of responsibility throughout the hospital. Her recurring complaint was that the interns needed more clinical responsibilities. They rightly felt, she observed, that they were “losing ground,” because “so many privileges that would be readily acceded to physicians elsewhere” were denied them at the NEH. They did not get what they needed the most—a a chance to manage patients by themselves. After all, Van Hoosen reminded the directors, although discrimination still existed, positions for medical women had multiplied over the last years and many of the interns could go elsewhere. “Where there was one opportunity for women 20 years ago there are now twenty. Opportunities for observing the best medical work are now ample in every city. What women want now is opportunities for doing.”⁸⁰

Once again, Zakrzewska’s response appears in retrospect unsympathetic and inadequate. Though she made vague reference to “important changes in the division of work” in the future, she again reminded her critics that “there is no position in life which does not have its annoyances” and that she expected better from “helpers, in one of the great historical reforms.” Unwilling to engage in a productive exchange of views, she invoked the cause of women in medicine, expecting compliance from young women interns merely because they were women at a woman’s institution.⁸¹

Contemporaries remembered Zakrzewska as “serious,” “aweinspiring,” not particularly harsh or cruel, and by her female colleagues “very much beloved.”⁸² And yet the qualities of defiance and determination that helped her to accomplish so much in establishing the New England Hospital on a firm footing worked against her at the end of the century, when flexibility and openness to new medical ideas became imperative. Her reluctance to respond adequately to the changing needs of a new generation of women under her authority, more and more of whom were coming to the NEH from progressive coeducational institutions like Michigan, gradually made the New England Hospital less attractive to women clinically, especially when hospital opportunities opened up elsewhere.

There were others at the NEH who were prepared to acknowledge the problem more readily than Zakrzewska herself. In 1895, for example, Dr. Mary Hobart, who had worked on the attending staff for nine years, bluntly warned her colleagues to change their ways. “It is well known,” she observed courageously at a physicians’ meeting, “that the staff of the New England Hospital already has the reputation of being narrow and to repulse bright women who might otherwise be valuable as co-workers.”⁸³

But it was Alice Hamilton, trained at Michigan in the early 1890s, who best summed up the problems the hospital faced, and her message seemed sadly to confirm Mary Putnam Jacobi’s worst fears: that separation, when it became isolation, could breed inferiority. Hamilton came to Boston in 1893 full of enthusiasm, but that excitement soon waned as she encountered outdated rules and inadequate opportunities for clinical experience. First, there was not enough work to do: “I have not enough to keep me busy,” she wrote her sister. “I feel that I am simply losing a year which I cannot spare.” But worse, she found the hospital “narrow, petty, squabbly, idiotic,” because of its ancient rules and regulations. “We have an amount of etiquette or red tape that would overstock Bellevue. Most of [the rules] date things years back and were made for interns who were only prospective medical students, but they are still kept up and handed down to us graduates.”

Hamilton’s most scathing criticism, however, was reserved for the attending physicians themselves: “The visiting physicians,” she wrote in disgust in 1893, are “bland and patronizing and so convinced that there is no hospital like the New England and no advantages like ours. They are narrow women who escape discovering their own ircferiority merely by avoiding their superiors. "⁸⁴ Such women, Hamilton lamented, needed to take refuge in extreme authoritarianism. The result was that the sort of girl who succeeded at the New England Hospital was “the one who rides rough-shod over her subordinates and cringes to her superiors.” Nor was Hamilton alone in her displeasure. During her internship at the NEH she became close with Rachelle Yarros, a graduate of the Woman’s Medical College of Pennsylvania and a woman who eventually became professionally active working for Hull House in Chicago. Together they bemoaned their fate at the hospital, giving each other support and encouragement during the all-too-frequent clashes with their superiors.

Hamilton thought hard about the reasons for the New England’s deficiencies. She concluded that its faults could not be blamed on “the fact that they are all women.” Indeed, she had a basis for comparison, because she had spent time before coming to Boston at the Northwestern Hospital for Women and Children in Minneapolis, a similar all-women’s institution founded in 1883 by a graduate of Philadelphia. The women at the NEH, she believed, were, in contrast to her mentors in Minneapolis, “narrow-women,” women “who lived in a state of self-distrustful antagonism to all men doctors,” and who “study gynecology and obstetrics and know absolutely nothing else.” She regretted leaving an “excellent place” in Minneapolis, she wrote to her cousin, in order to come to an institution that she discovered to her disappointment was “living on the ashes of its former reputation.” It rankled her that women physicians still had not enough good internships to choose from, and that a place like the NEH was thus not under enough pressure to change its ways. “It irritates me to think,” she burst out, “that there is not a man medical graduate in the country who would accept so inferior a position as this; yet here we are, who know just as much as men students, obliged to accept places where we must divide with six the work that is only enough for two.”⁸⁵ Hamilton was unable to tolerate the situation. In April 1894 she resigned from the hospital.

It would be a mistake to conclude either that the New England Hospital’s difficulties were typical of all women’s hospitals, or that all the women who interned there had an unhappy experience. There were those who believed, along with Josephine Baker, that the institution “fitted my needs admirably. It was staffed entirely by women of first-rate calibre.... It provided a wide range of medical, surgical and obstetrical work.”⁸⁶

Many of the New England’s problems had to do with the personality of its founder, Marie Zakrzewska, and the women she gathered around her. The product of an earlier struggle, Zakrzewska advocated a brand of feminism that could potentially divide the loyalties of women seeking to be both women physicians and members of a larger, integrated professional network. While successfully preserving the female character of her institution in the crucial years, her inflexibility rendered her ideas antiquated by the 1890s, and jeopardized the hospital’s reputation both among the male profession and among younger women physicians.

The hospital’s aura of feminist militancy annoyed some more than others. Alice Hamilton never adjusted to it. Margaret Noyes, on the other hand, took it in stride. Fifty years later, while reminiscing about Dr. Mary Smith, the woman superior Hamilton disliked so intensely, and her partner, Dr. Emma B. Culbertson, Noyes could still describe the pair’s idiosyncracies with good-natured humour:

It would be helpful to know more about how other women’s hospitals faced such dilemmas, but the information is too fragmentary. The New York Infirmary remained a small but respectable woman’s institution through the first half of the twentieth century, in part because of the devotion of several wealthy female trustees. It did not develop the reputation for abrasiveness that eventually warned some women physicians away from Boston. Yet the fate of women’s hospitals elsewhere suggests that Zakrzewska’s fear that too much flexibility could lead to a loss of identity was real. Neither the Woman’s and Children’s Hospital in San Francisco, nor the Northwestern in Minneapolis, for example, remained exclusively female-run institutions for very long into the twentieth century. San Francisco Children’s eventually affiliated with the University of California, and by 1900, though it still sought only women interns, there were a number of male physicians on the attending staff.⁸⁸

In Minneapolis, Northwestern Hospital eventually merged with Abbott Hospital, a private institution founded by a male physician, and became connected with the University of Minnesota. Both these institutions, and many others like them, weathered the transition from nineteenth- to twentieth-century medicine with foresight and skill. But in the process their exclusively feminine character first diminished and then disappeared. No doubt Zakrzewska dreaded such a fate for the New England, and her fears likely nurtured the atmosphere of “distrustful antagonism to all men doctors” which so disgusted Alice Hamilton in the 1890s. But Hamilton represented the attitudes of a new generation of women physicians, one which appeared more relaxed in a coeducational professional world, in part because their own experience with discrimination was more subtle. Yet this generation, too, cared a great deal about the future of women in medicine, and it would be incorrect to conclude that they rejected entirely the benefits of female medical networks. On the contrary, many younger women would feel more acutely torn than their elders were between separatism and assimilation, and the psychological confusion that accompanied such tension could at times be painful, even confusing.

We must remember that the marginality of women physicians like Zakrzewska was never entirely self-imposed. The pioneer generation had fought tirelessly for entry into male professional societies and for the right to consult with male physicians. But such access came neither easily nor all at once. In some regions, including much of the Midwest, women gained admission to local and state societies quietly and without incident. In other places, such as Massachusetts, Philadelphia, San Francisco, and Washington, D.C., the struggle was bitter and protracted. The Massachusetts Medical Society, for example, one of the most stubborn, first considered the idea of admitting women in 1850 and again in the 1870s. However, it was not until 1884 that the friends of women physicians finally succeeded in winning their goal. Even the American Medical Association preceded Massachusetts, by agreeing in 1876 to seat Dr. Sarah Hackett Stevenson, a female delegate from Chicago-although the acceptance of women in the AMA remained only de facto, and was not formalized until 1915.

Women physicians exposed the hyprocisy of male objections at every opportunity-especially complaints that women were not adequately trained. Wrote the dean of the Woman’s Medical College of Pennsylvania in a commencement address in 1879, “An objection sometimes urged by our medical brethren to the admission of women into their organizations is that ... women like men must show themselves qualified before expecting recognition. But is qualification the invariable standard for men? I think not. Occasionally, at least, it is not competence but the diploma which is made the open sesame of doors still closed to us.”⁸⁹

Such difficulties were never easy to overcome. For example, Harriet Belcher wrote of assisting with four other women physicians at a delicate operation to remove several ovarian tumors early in her career. Waiting to see if the patient would recover was “a mental and physical strain,” and Belcher confessed to “utter thankfulness” when she “saw her coming through safely.” The patient’s recovery “meant to us not only a life in which we had a strong personal interest, but success or failure was so much more to us professionally that it would have been to men.” In addition to the burden of having to prove themselves continuously, women often disliked being outnumbered even after they gained entrance into the male societies. Feelings of isolation may account for their low professional participation, even where the opportunity to do so was available.⁹⁰ In a report published in the Alumnae Transactions of the Woman’s Medical College of Pennsylvania in 1900, Ida C. Barnes, Class of 1890, wrote from Topeka, Kansas, of women’s cordial acceptance by the medical societies in the state: “Their membership in the societies is as eagerly sought as that of their brother practitioners,” she reported, and they were often invited to give papers and to hold office. Indeed, she concluded, “Women physicians in the West, at least, could have more positions in the medical societies if they would attend more regularly, and give close attention to the reading of papers and to the business of the session”⁹¹

Similarly, the editor of the Colorado Medical Journal chided women physicians in his state for their poor participation in medical society activities. Conceding that the women were “truly ... doing nobly by their profession,” he nevertheless complained that they gave too much attention to their own organization, the Denver Clinical Society. “That society,” he argued, “is properly classed with the special and restricted societies, membership in which should supplement and not supplant that in the general societies.”⁹²

Ironically it was in the cities in which women had already gained admission to the larger medical associations that local women’s medical societies were most likely to appear. These societies apparently evolved to strengthen ties between women professionals where networks of female physicians already existed. Sometimes, as was the case in San Francisco, Boston, Minneapolis, Washington, D.C., and Philadelphia, charter members had already cooperated in founding a hospital or a dispensary. Stressing primarily the importance of female professional companionship, these groups served as clearing houses for the exchange of scientific information, and occasionally as pressure groups for social action. Founders often explained the decision to organize, not by pointing to overt discrimination, but by citing the more subtle effects of their minority status. Mary Stark, for example, a charter member of the Practitioners Society of Rochester, founded in 1887, explained:

The situation of women doctors in Iowa was not very different from those in Rochester. In 1901 there were over seventy women physicians.⁹⁴ Iowa’s male practitioners were praised in the pages of the Women’s Medical Journal for their justice, courtesy, and liberality toward women colleagues. Not only were women admitted to all medical societies, but they were also accepted in official positions of all kinds and sent as delegates from local to state and from state to national conventions. In 1893, for example, Iowa was represented in the Pan-American Medical Congress by a woman. The state’s hospitals for the insane were among the first in the country to include women on the staff, and the majority of general hospitals had one or more women on either the active or consulting staff by the turn of the century. The Iowa State Medical Reporter and the Iowa Medical Journal had female assistant editors. Finally, the medical, pharmacy, and dental schools in the state were all coeducational.

But a woman’s medical society fulfilled a need in the lives of women doctors that even this liberal atmosphere of acceptance could not totally satisfy, and consequently the State Society of Iowa Medical Women was founded in 1898. As Dr. Azuba King explained in her 1901 Presidential Address to the group: “Our professional brothers long ago recognized the truth: In union there is strength ... let us profit by their example. The woman physician—alone either in city or town has an isolated professional life, the brother practitioner may be courteous, and ethical—she is alone nevertheless. ⁹⁵

Those women who did not have families longed for the intimacy that shared goals and shared experience could provide. Others craved social, professional, and psychological support. The women’s medical societies gave this sought-after fellowship, while simultaneously training their members in the unwritten “rules” of professionalism. Often, for example, the women’s society proposed its members as officers in the regular state society. In 1901 two of their candidates were elected without fanfare to high offices in the Iowa State Medical Society. Local societies also coached younger and timid or reserved women in self-confidence before they went on to grapple with the forbidding world of male colleagues.

For example, though the Iowa Women’s Medical Society especially urged its members to submit papers to the regular state medical meetings, it also gave them the chance to deliver their remarks before an all-woman audience first. Here, at the intimate meetings of the women’s society, the “less experienced” could “with friendly criticism,” cultivate their powers of expression, stimulate growth in their professional life, and develop their capabilities. In 1902 the society’s president, Jennie McGowen, explained that the Iowa Women’s Society was

The professional work of women physicians, as it developed in the late nineteenth and early twentieth centuries, generally drew them toward “feminine” areas of endeavor—public health and the teaching of social hygiene, work with adolescent girls in schools, gynecology, pediatrics, obstetrics. This was true because cultural and professional sanctions concerning proper behavior for a woman doctor converged with women physicians’ sincere desire to make a contribution to the profession that was uniquely their own. With professional lines hardening at the end of the nineteenth century, women continued to be tracked into the less glamorous, lower-paying medical roles. Yet these roles also seemed to be the very positions that put them in touch with what they cared about most in medicine: female health, family life, and the scientific management of child growth. These concerns linked them most closely with the private sphere. Like Mary Putnam Jacobi and Elizabeth Blackwell before them, women physicians continued to criticise the narrow professionalism and crass materialism that they often found characteristic of their male colleagues, offering instead the compassionate dedication to serving others that they themselves considered woman’s particular strength. Ida Reel (WMCP, 1882) for example, continually deplored “mercenary physicians ... those who are only in the profession for the money they can get” and wore her modest means like a badge of honor. “I haven’t made much money,” she wrote her fellow alumnae at the Woman’s Medical College in Philadelphia, “but there is a satisfaction in the gratitude of patients—a satisfaction which money couldn’t buy.” Similarly, Dr. Mary McKibben-Harper, in a retrospective article on Anna Broomall, found it particularly noteworthy that Broomall kept her fees to the minimum on principle. “She had great fear,” remarked Harper admiringly, “lest our profession became commercialized. ”⁹⁷’

Thus, no matter how successful individual and exceptional women physicians would be in integrating themselves into the male professional world in the late nineteenth and early twentieth centuries, as a group women physicians remained poised around the edges of that world, making contributions that were socially useful but otherwise devoid of the flashy éclat which measured success by male professional standards. Marginal to their profession, perhaps, they still made substantial contributions to the community. Beula Sundell, a graduate of the Woman’s Medical College of Pennsylvania in 1930, might well have spoken for several earlier generations of medical women when she answered, with a combination of defensiveness, apology, and pride, a questionnaire about her career sent out by her alma mater: