CHAPTER 10
The Emergence of Social Medicine: Women’s Work in the Profession
While the needs and interest of women physicians are inseparable from those of men, they are by no means identical; and we earnestly hope and believe that in all questions of family life, with sanitary, moral and social problems, they will raise the tone, widen the perception and alter the attitude of the profession in general, so as to make it respond more perfectly to the needs of society, and exert a high power for good in all directions. If this be realized, it will be seen that the work of women is absolutely essential and of ever increasing importance and the outlook for this in every respect most helpful.
William H. Welch, Women’s Medical Journal,
October 1913.
 
The woman’s movement is but a part of the evolving energy that is developing the human race. We cannot stay it if we would; we are an integral part of it.
Margaret Colby, M.D.,
President of the Iowa State Society
of Medical Women, July 1902.
 
 
In November 1915 a number of prominent women physicians in Chicago gathered together at a banquet organized to celebrate the fiftieth anniversary of the founding of the Mary Thompson Hospital. After the toasts and speeches praising the achievements of women physicians, Mrs. George Bass, ex-president of the Chicago women’s club and a longtime trustee of the hospital, took the podium. Her words, unlike many which had been spoken that night, reflected anger and disappointment at the difficulties women physicians were having gaining proper recognition from their professional brethren. Her advice was to use separatism as a strategy: “Appreciating your inner reluctance to segregating yourselves in any way from the body of your profession,” she began, “I yet ask, what have they done for you? The time is doubtless long past when they actively opposed your entrance into the profession, or openly flouted you on your way,” she conceded. “But no propaganda has ever emanated from them voicing to the public your place in the profession and your especial value to the community. There has been no cordial offering of hospital and research privileges and no recognition upon boards of authority. I do not believe,” she concluded, “that this is oversight.”1
As Mrs. Bass’s words suggest, women physicians continued to be plagued by conflicts between separatism and assimilation, and the professional world of twentieth-century medicine exacerbated rather than minimized tensions between the two postures. They struggled first with the problem of the continuing legitimacy of their separate organizations and institutions. Did these help or hinder the cause? Did efforts to attract women physicians to their own associations result in the inferior duplication of services they could already receive from professional organizations already in existence? Did a separate medical college for women strengthen or weaken women’s position in the larger professional arena? And what of women’s role in medicine itself? Did they belong in all specialties, or just those that dealt more directly with women, children and family, and community problems? The rise of modern medicine did not lay to rest the pressing issues of the nineteenth century concerning women physicians, but merely reformulated them in a different and more modern context.
Certainly the idea that women physicians needed their own organizations was not new. In the 1890s, as local women’s medical societies flourished, women physicians told themselves that “the supreme force of the present age is organized effort” and that “we need our medical societies ... for the purpose of combining our thoughts and efforts for the betterment of our own conditions and to enlarge the field of our own usefulness.” “Let not the woman who enters the medical profession think for a moment,” added Margaret E. Colby in her presidential address to the Iowa Society of Medical Women in 1902, “[that] she is going to have smooth sailing.” Separate organizations, agreed the editor of the Medical Woman’s Journal, offered “the power of united instead of single influence.”2
Women physicians justified the strengthening of separate organizations in the new century on several grounds. First, they saw organized, constant pressure and disclosure of discrimination as a means to preserve their gains and to widen medical opportunities for women. In this spirit the Woman’s Medical Journal kept them abreast of new hospital opportunities, the opening of medical schools to women, and professional achievements. Periodic reports delineating postdoctoral medical programs, possibilities for residencies, the numbers of women in medicine and their distribution in the specialties provided a good deal of information on the progress of the woman physician in the opening decades of the new century.3
Having their own journal also gave women a chance to publish. Bertha Van Hoosen, a prominent surgeon in Chicago who completed a number of pioneering clinical studies on the use of “twilight sleep” in childbirth, bitterly remembered her own rejections from the Journal of the American Medical Association. A graduate of Michigan, she admitted that sex discrimination had meant little to her until she had begun to practice medicine. Indeed, in the beginning she had even refused to subscribe to the Woman’s Medical Journal. But when her first article was returned from JAMA “with a none too gracious note,” she changed her mind. Despite her prominence as a surgeon, JAMA never published one of her papers, and she confessed in later years that she kept “a box filled with ‘Jilts from the Journal’ letters.”4
Similarly, the Woman’s Medical College of Pennsylvania justified its own existence on the grounds that it made available to many women a chance to study medicine that they otherwise would not have had. As Ellen C. Potter, a graduate of the school in 1903 and for a long time commissioner of health for the state of Pennsylvania, observed, “So many of us of that generation would never have been able to enter a medical school if it had not been for W.M.C.” Even in the early years of the new century doubts lingered in the minds of many that coeducation would offer the promised rewards, and some felt, along with Eliza Root, that coeducation in medicine was “serving a term of probation.” It remained to be seen, Root cautioned, whether or not women were relegating themselves to “a long and severe apprenticeship in which promotion will be painfully slow and uncertain.” The separate college for women, she claimed, “still has work to do.”5
Over and over again supporters of separate education pointed to the importance of female role models. Many women physicians, like Alice Weld Tallant, the product of a superior coeducational school, saw the significance of female role models only after they observed a woman in a position of authority for the first time. After Tallant’s experience in her internship observing competent women surgeons, she understood as she never had before the role of the Woman’s Medical College in providing psychological incentives to female students. In 1927 Bertha Van Hoosen reaffirmed Tallant’s observations by publishing an article in the Medical Woman’s Journal demonstrating that all-male faculties tended to inhibit women’s professional aspirations, especially in fields increasingly defined as “male preserves.” Investigating the educational histories of the 51 female fellows of the American College of Surgeons, she discovered that 50 percent of them were graduated from a woman’s medical college, while an additional 25 percent served internships in hospitals staffed entirely by women. Van Hoosen concluded that considerable thought should be given to the “psychological effect of being trained by women surgeons and physicins.”6
Some were thus convinced that separate institutions at the very least lessened the corroding effects of discrimination. Others felt that separate institutions could also preserve and strengthen female “spheres of influence” within the profession as a whole, thus making an impact in a larger arena—that of medical practice. This argument merely updated Elizabeth Blackwell’s contention that women had special qualities to bring to the profession, and it remained a powerful weapon in women physicians’ arsenal, finding novel modes of articulation in the twentieth century.
In an address to the alumnae of the Woman’s Medical College in 1912, for example, President Eleanor C. Jones suggested that coeducation would never solve women’s needs. “In these co-educational schools,” she emphasized, “the main purpose is, of course, to fit men for the practice of medicine, and the courses have been developed to fill these masculine needs.” For Jones it was decidedly a drawback that these schools subjected women to precisely the same courses of preparation as the men. The result was physicians who were “trained to carry on afterward precisely the same kind of work as men, in the same way.... As a consequence women in the medical profession have in a measure entered into competition with men on ground already occupied, and have, per-force adopted their methods and aims.”7 For women like Jones, nothing could be more wrongheaded than teaching women professionals to behave exactly like their male colleagues.
One important social development that gave particular credence to this point of view was the reemergence of liberal reform and the increasing visibility and influence of women reformers in the years after 1900. So conspicuous were women and women’s concerns in reform activity in the decades between 1900 and roughly 1930 that many saw this period as the culmination of the long struggle by social feminists to make their impact felt in the public sphere. “As some one has said,” quipped Dr. Jones, “the twentieth century has witnessed a glorious birth, and it is a girl!” New circumstances meant that women physicians too must give special thought to their own role in social change: “It is becoming recognized,” she concluded, “that society needs the special feminine qualities nearly as much outside the home as in it, and it is probable that soon women can reckon on a more genuine appreciation of their special feminine gifts. When this time arrives, will they not naturally endeavor to secure a training that will emphasize their special capabilities along their own lines?” Renewed interest in the child and the family prompted Dr. Jones, like Elizabeth Blackwell before her, to conclude that it was more “practical” than ever for a woman’s medical school to exist that could offer a curriculum “in the interest of women alone, that is, a curriculum which intended primarily to fit women for the practice of medicine in whatsoever way their needs in the future might demand.”8
The difference between Blackwell and her successors was at once profound and insignificant. On the one hand, these were women who were trained in scientific medicine, and who generally accepted its implications both for the reform of medical education and for changes in practice. Consequently, they were less critical than was Blackwell, the product of another time, of the “modern” medical model, which Blackwell had equated with the victory of the male principle over the female—the triumph of “science” over “intuition.” On the other hand, they still adhered to a vision of their own role that incorporated the idea of female uniqueness. Though fewer and fewer of them grounded their sense of this difference in biology, as the century progressed, many women physicians still expected that women’s concerns in medicine would not be the same as men’s.
One eloquent proponent of this point of view was Lilian Welsh, a graduate of the Woman’s Medical College of Pennsylvania in 1889, who had spent a year abroad studying bacteriology and who had originally planned a career in research. Thwarted in these plans by the lack of opportunity, Welsh nevertheless kept eagerly abreast of scientific developments in medicine, maintaining a warm personal and professional relationship with Florence Sabin. She remained a loyal alumna of Woman’s Medical, attending the yearly alumnae meetings and taking an enthusiastic interest in the fate of the school. For several years she represented the alumnae on the Board of Corporators. One can follow her initial depression regarding the fate of the school in her comments at the yearly alumnae meetings after 1900. Deeply worried about a shrinking endowment and the difficulty of keeping pace with the advancing standards of medical education, she came to doubt whether the college could be of service in any way to woman physicians. “Unless it can take its place once more with really first class schools,” she warned, “its existence might even be detrimental to the position of women in medicine.”9
In September 1911, Welsh had an experience that dramatically altered her increasingly doubtful attitude about the future of the college. She attended the International Congress for the Prevention of Infant Mortality as a representative from the United States. In Berlin she heard a great deal about European efforts to reduce infant and maternal mortality rates. There, the importance of modern instruction in pediatrics and obstetrics was repeatedly emphasized. While Sweden outshone all the other European countries in its boast of “one of the lowest rates of infant mortality in the world because it made pediatrics a distinct department of medicine over thirty five years ago,” the United States with its shockingly high rates of mortality and its abysmal record on the teaching of obstetrics and pediatrics in the medical schools had been “dismissed” by all the delegates “with a word of amusement.” Welsh’s shame at the failings of her country’s medical profession gave birth to an idea: The Woman’s Medical must capitalize on the interest of progressive reformers in these subjects.
In all the present day discussion in the feminist movement the loudest cry from the “anti” is “The function of women is to bear and rear children!” While the “pros” march proudly under the banner, “We prepare children for the world, let us prepare the world for our children!” Is it not then fitting that a well-established medical college, devoted to the medical education of women, should take a new lease on life in retaining and establishing leadership in teaching these two branches of medicine which especially concern women—obstetrics and pediatrics? I believe no pleas for increased endowment would receive greater consideration from a contributing public, than the plea that a woman’s college desires to take advanced standing in teaching these two subjects, now inadequately taught in most of the schools of our country.
Trends in medicine, too, were responding to progressive ideology, and a greater emphasis on preventive medicine—an area of interest to women in the past—appeared inevitable to Welsh:
Both research and social medicine today are opening up fields of remunerative employment, that are not only attractive to women, but that particularly need the services of women medically trained. The field of medicine, both curative and preventive then, we may say, presents some problems that are essentially the problems of women, and for their solution special training for women students should be provided. Where can such training be better given than in a School of Medicine for Women ... ? In my vision I see ... a school of medicine designed especially to meet the needs of women—a school that shall primarily be a first class medical school, providing a thorough education in the fundamental medical sciences, but which shall place special emphasis on teaching obstetrics and pediatrics, and shall in addition provide adequate and special training for research, and for service in preventive medicine along those lines which women may best interpret. This school will proudly bear the inscription:10
 
The Woman’s Medical College of Pennsylvania
Trains
Properly Qualified Women
for
Research Practice Preventive Medicine
in Especially as
Laboratories among Health Teachers
and Women and Officers of Hygiene
Institutions Children
Social
Workers
 
 
While presenting these ideas to the alumnae association in 1912, Welsh discovered that many women shared her vision. Clara T. Dercum agreed that “there certainly is a need for training women in certain lines. We do not want to be trained exactly as men. We want the same foundations in research work, etc., but when it comes to the practical application of our knowledge, we want to do it in a woman’s way.” Eleanor Jones, of course, concurred, speculating that perhaps the reason medicine had ceased to draw “to itself a due proportion of the finest women in the community” had something to do with the fact that scientific medicine was no longer offering them “up to the present time, just that which best satisfy their intellectual and spiritual needs. Women are so constituted,” she felt, “that they can not do their work along just the same lines as men.”’11
In keeping with the suggestions of Welsh and others, the Woman’s Medical College mounted a publicity campaign that emphasized its ability to meet the special educational needs of women physicians. Combined with the campaign itself was an effort to build its offerings in obstetrics, gynecology, and pediatrics. By 1915 its program, while meeting the AMA standards in terms of teaching hours in all subjects, exceeded by almost double the amount of time devoted to preparation in obstetrics and gynecology, well surpassing the programs of schools like Cornell, the University of Michigan, and the University of Illinois. As Mary Sutton Macy observed in the Woman’s Medical Journal, “The Woman’s Medical College of Pennsylvania surpasses by far all the other colleges of the selected group in the time devoted to gynecology and obstetrics.”12 In this manner the school walked a thin line between finding a convincing rationale for its continued existence without compromising the scientific standards.that had become the hallmark of modern medicine. Judging from the support it received from various quarters during its periodic bouts with financial difficulties, such a strategy achieved for the college a measure of success. It remained in respectable existence as an exclusively woman’s school for another half century. 13
And yet, despite the extraordinary power of the Blackwellian tradition, women physicians in the twentieth century understandably displayed much more ambivalence toward separatism as either an ideology or a strategy. Some of this ambivalence can be detected even on the pages of the Woman’s Medical Journal, which often took extraordinary pains to explain that its position was not segregationist. In a curious editorial in 1909, for example, Margaret Cleaves rejected “the exploitation of women physicians as a separate and distinct labor from the rest of the profession,” declaring that “science knows no sex and should know none.” The function of the Woman’s Medical Journal, she wrote, “should be for the advancement of medical science without relationship to sex.” And yet Cleaves felt the need to conclude her article by staking out claims for women doctors who “have shown themselves peculiarly fit” for “scientific research, treatment of the insane, social purity work and preventive medicine.” A year later another editorial tackled the issue again. “We cannot state too emphatically,” wrote the editors in 1910, “that we are unalterably opposed to the segregation of women physicians or of their work, since in medicine all are physicians first, women and men afterward.” But once again the editors concluded with a gentle reminder to readers that “women cannot work harmoniously with men until they learn to work harmoniously with each other,” and that because of discrimination in hospital appointments and academic departments “the needs of the woman in the medical profession today are somewhat different and more urgent than those of the man.”14
The care with which the Journal dealt with the issue of separatism suggests that it aroused negative responses from a number of women physicians. And, indeed, younger generations of women who had come of age with the triumph of coeducation were understandably suspicious of the idea of women keeping to themselves. A poignant illustration of the shift in attitude can be found in a curious exchange which took place among the alumnae of the WMCP at their annual meeting of 1892. One of the members raised the question as to whether in the future the annual alumnae dinner should continue to be restricted to women. A debate ensued that demonstrates that for these women, the issue was not a simple one. Mary Putnam Jacobi, always suspicious of a certain kind of professional separatism, also understood women’s need to gain professional self-confidence through their own organizations, and opposed the idea, suggesting with great insight that “we are not yet sufficiently familiarized with the business to invite critics from the specially dinner-giving and speech-making sex.” Calista V. Luther agreed, feeling that “at present I believe we had better keep to ourselves.” But many felt that inviting men would make the entire organization look more profesional. “I am very anxious,” dissented Dr. Sarah Weintraub, “that we should have representative men of the city ...” to “add to the standing of the Alumnae.... I think we keep to ourselves too much. If we could have some of the men who are interested and of influence,” she added, “it would be a great advantage.” And Dr. H. W. B. Carter confessed, “I know ladies, that we old ones do not care so much about having the gentlemen, but the younger ones do.”15
With the achievement of coeducation after the turn of the century, militant separatism appeared to many to threaten the possibility that men would welcome women colleagues as equals. The Woman’s Medical Journal admitted that “there has been among some the impression that united action on the part of medical women, would create a feeling of exclusion” which would result in “a change in the existing pleasant relationship” between men and women doctors It seemed to a younger generation that the battle over equal intelligence had ended, and they lacked the pioneer determination of their elders because in fact significant advances had been made. Consequently, many women rejected formal contacts with professional women’s associations. Nowhere was this ambivalence played out more powerfully than in the history of the American Medical Women’s Association.
The Medical Women’s National Association (later changed to the American Medical Women’s Association) was founded by a core of active feminists who were tired of their marginality within the profession and women physicians’ weak group consciousness. A small gathering, including Drs. Marion Craig Potter, Martha Whelpton, Bertha Van Hoosen, and Mary Bates met with Mrs. George Bass, then president of both the Chicago Women’s Club and the Board of Trustees of the Mary Thompson Hospital, in the offices of the Women’s Club one evening in November 1915. After a select committee drew up a constitution and bylaws for the embryonic organization, the Medical Women’s National Association was born, boasting a slate of officers including Dr. Bertha Van Hoosen, president; Eliza Mosher, honorary president; Marion C. Potter, first vice president; Mary Bates, second vice president; Mary McLean, third vice president; Martha Whelpton, secretary-treasurer ; and Dr. Margaret Rockhill, the loyal editor of the 16 Woman’s Medical Journal, corresponding secretary.
Building on the custom established in 1908 of holding a banquet for women physicians at the yearly AMA meetings, the first regular meeting of the new organization took place a year later in Detroit, in conjunction with the meetings of the AMA. There, the group dedicated itself to advancing the cause of medical women, and Eliza Mosher gave a rousing address which “so thrilled the audience with her Great Personality and high ideals of love and service for other women that those present felt that indeed this National Association was consecrated to the highest service for medical women.”17 The group made the Woman’s Medical Journal its official publication, and later published its own Bulletin.
In May 1916 the Woman’s Medical Journal published one of several editorials explaining the philosophy of the new organization. Careful not to offend the assimilationists, the title read, “Amalgamation, Not Segregation.” “The woman physician probably finds less restriction to her activities in the city of Chicago than in any other city in the United States,” the Journal began.
Nevertheless, it is a fact that in that city of more than one hundred hospitals ... there are two hospitals only whose doors are open to women internes.
The woman physician is admitted, and usually welcomed, to nearly all the State and County Societies in the United States; still, we know of no Gynecological or Obstetrical Society, national or local, which opens its membership to women.
If the women medical students desire to investigate the causes for their exclusion from these various hospitals, should the term “segregation” be applied to the young women, or to the hospitals excluding them?
If the women who are specializing in gynecology and obstetrics endeavor to overcome the conditions which prevent their admission into national or local gynecological and obstetrical societies, will the term “segregation” belong to them or to the societies excluding them?
The remedy for segregation is organization. Organization is the guiding star of the Twentieth Century, and leads on to Liberty, Equality, and Fraternity. Organization of women outside of the profession will be equally effective and will hasten the day when it can be truthfully said, “There is no sex in Medicine.”18
During the next year the new president of the Medical Women’s National Association created a number of important committees—on Public Health, Race Betterment, and Medical Opportunities for Women, for example—which would take liberal positions on social issues throughout the 1920s. However, the group’s immediate concern quickly became war work. Interestingly enough, it was probably the ambivalent response of the United States government to women physicians’ desire to aid in the war effort that virtually guaranteed the future existence of the organization.
Torn between their “professionalism” and the real attractions of their own organization, many women physicians withheld support from the National. In fact, condemnatory petitions were immediately circulated in response to its establishment, with opposition particularly strong on the West Coast. Perhaps California’s ncharacteristically positive record on the admission of women to medical school accounted for the negative response of its women physicians, but, whatever the cause, disapproval of a separate organization remained strong. Then, shortly after the entrance of the United States into World War I, the surgeon general, who had been inundated with applications from thousands of patriotic women doctors, refused to commission them in the army. Almost overnight, doubts about the usefulness of a separate organization disappeared, and women from all over the country united behind Van Hoosen’s efforts to challenge the surgeon general’s humiliating policy. Though efforts to gain commissions for women failed, the National did create its own War Service Committee, later retitled American Women’s Hospitals. One of the most successful arms of the National, this committee sent hundreds of women physicians overseas for active duty in war and postwar relief during the four major wars of the twentieth century. American Women’s Hospitals still funds rural and urban clinics for the benefit of the poor and needy in Asia and Latin America.19
And yet, as war enthusiasm waned, so did the interest of many women physicians in the National. Prominent women, such as Florence Sabin and Alice Hamilton, maintained strong and close contacts with other women physicians, but kept aloof from separate organizations. Hamilton was always pleased to speak to the National on issues of concern to her, especially the importance of protective legislation for women and her opposition to the Equal Rights Amendment. In her private correspondence, too, she occasionally exhibited concern for “the status of women in our profession.” Her primary interests always lay elsewhere, however, and not with women physicians as a group. Typically, she once declined to write a review of Kate Campbell Hurd-Mead’s history of women physicians, saying, “I am a poor feminist when it comes to magnifying the achievements of women.”20
Sabin harbored even stronger feelings on the issue of separatism, though, unless asked, she kept her opinions very much to herself. She never publicly denigrated women’s institutions, and once “mildly chided” a female Hopkins student for not displaying enough respect for the Woman’s Medical College of Pennsylvania. In 1922 she gave the commencement address at the women’s school. Yet in 1936 she refused to allow her name to be added to a committee of supporters of the College as a fund-raising measure because she confessed that she was “sceptical as to the necessity and the wisdom of maintaining a medical school by and for women at this time.” And though she maintained warm relationships with both Bertha Van Hoosen and Kate Campbell Hurd-Mead, each extremely active in the Medical Women’s National Association, she declined to allow either of them to pull her in. She even shared with them her private skepticism about the necessity of the organization, writing to Mead in 1935:
I still feel very strongly that the position which the women in the scientific branches have taken, that of joining their professional organizations and taking full part in them, is a much stronger position than could be filled by any separate organization of women. As I go to various scientific meetings and hear women read papers in the major organizations and compare that work with that of the few meetings of the Medical Women’s Association that I have attended from time to time here in New York, I feel quite confident that to cast one’s interest into the medical profession accomplishes much more for women than the separate and, as they seem to be, feebler organizations. 21
Younger generations of women physicians were even more suspicious than Sabin of what they perceived as feminist militancy among the members of the National. Many shared the sentiments of Ethel Walker, a pediatric resident of Johns Hopkins Hospital, who coolly explained to Bertha Van Hoosen her reasons for declining to join the organization:
I am strongly opposed to any organization or individual’s attitude which sets women apart from men ... instead of teaching them to lose themselves in their profession.... In the early days of women in medicine they no doubt had to band together, but now in most sections of the country if not all the quicker the woman physician can forget any feeling that she is in a class apart from her men colleagues the happier she will be and the better she and they will get along. In medical school and interne days I have seen it happen time and time again that the girls who were totally unconscious of any difference between themselves and their men confreres and who mingled with them on exactly the same footing achieved a professional equality and friendship which was entirely denied to the women who were always huddled together with other women and who continually made it plain to everybody that they were different and knew they were different. In my experience it has been the former group who did well in their profession ... whereas the other group of women’s women ... seldom advanced.22
Coupled with the National’s problems over women physicians’ ideological diversity was the fact that some women were simply not joiners. In an effort not to appear in competition with the American Medical Association, the MWNA deliberately required that all members belong to the AMA’s constituent county and state societies. When only 48 percent of medical women were AMA members compared to 60 percent of the men, it meant that even fewer would belong to the women’s organization. Membership committees complained that women were too involved in practices to show much interest. Typical were the excuses of Rosemary Shoemaker, M.D., who wrote in 1939 that she had just opened an office in Des Moines and was still waiting for her first patient. “I think I should like to wait before requesting active membership until I see how my practice develops.” Other women complained of the pull of family ties. Jane Sands Robb explained that “for the last seven years, I haven’t been a member of any hing.” Her husband was ill, had convalesced, and then decided to study medicine. She had two children. “These responsibilities have been so great,” she wrote apologetically, “that it has been necesary for me to stop all my affiliations. The only exception has been the American Physiological Society.... It hurts my pride to make this explanation and I trust you will regard it as a personal communication.”23
Thus, for many different reasons, only the most militant and feminist women joined the American Medical Women’s Association after 1915. Although the organization not only advanced the cause of women in medicine but also supported such various sociomedical issues as liberalized birth control laws, medical insurance, Medicaid, Medicare, and abortion reform, its membership rolls never attracted more than one-third of the women physicians in the country.24 Lamented the Bulletin of the MWNA in the mid-1920s:
But all our Big Women have not come in. They know that this National Society is a factor in the life and progress of Women in the profession, but for one reason or another they withhold cooperation. The same thing is true of the rank and file in the profession. Opposition has arisen from an honest opinion against sex distinguishment and also an apprehension that a Woman’s Organization would seem to be a pulling away from the A.M.A. and local Societies; and apprehension that it would add to the prejudice of the men in the profession where such prejudice exists.25
Despite women physicians’ uneven success with maintaining their separate organizations, their suspicion that coeducation would not be the answer to their dreams, and the poignant attempts of the Woman’s Medical College of Pennsylvania to keep itself alive, their public pronouncements during this period indicate much optimism and high hopes for significant professional advancement. To read the minutes of the Medical Women’s National Association, or the pages of the Woman’s Medical Journal, is to discover that women physicians’ major preoccupations were not with shrinking educational opportunities or the social and professional prejudice against them. On the contrary, the mood was one of buoyant optimism, marred only by the lament that good women were no longer choosing to study medicine, and this at the very moment when employment opportunities for medical women were allegedly brighter than before. In the year that Abraham Flexner published his report on medical education, the Woman’s Medical Journal did its own survey of the status of medical women. Concluding that in many areas opportunities have “advanced by leaps and bounds” the Journal complained that “the number of women ... who are entering the profession is not keeping pace with the increasing opportunities.” Two years later the president of the Alumnae Association of the Woman’s Medical College of Pennsylvania talked of “great opportunities,” and the “crying need” for women physicians, while Marion C. Potter, president of the Women’s Medical Society of New York State, deplored the fact that “numerically women physicians have their limitations,” because “sociological needs of all kinds appeal to them, and make unceasing demand on time, talents, and resources.” By 1919 the Committee on Medical Opportunities of the Medical Woman’s National Association admitted, “We want to hunt more women to study medicine. We have not enough to fill the places. The places are waiting in every state.”26
In reality, the situation of women physicians was far more complex and profoundly less secure than they perceived it to be. Surely we cannot take their own optimistic assessment at face value. But why did they greet the first decades of the new century with such sanguine expectations? The answer lies, I believe, in the ascendancy of a progressive ideology, and women physicians’ vision of their own role in early twentieth-century liberal reform.
Characterized by the confluence of a number of different streams of reform and by a general philosophy of public good which sought to elevate the character of the American population and inculcate a higher standard of individual behavior, reform in the opening decades of the twentieth century emphasized civic responsibility and social duty. Probably Herbert Croly described its spirit best when he contrasted the old “live and let live” with the new “live and help live.” The passing of the traditional community-centered social structure and the rise of large impersonal urban centers demanded thoughtful solutions to novel problems of sanitation, housing, poverty, education, recreation, and the corruption of political life. The need for innovative programs gave rise to an unprecedented burst of reform activity which spilled over into every aspect of modern life. 27
Reformers focused their attention on a number of different symbols, but perhaps the most powerful, especially for women physicians, was the symbol of the child. Many of the campaigns for health, education, and a city environment conducive to social well-being had the improvement of life for the next generation as the goal. Insofar as there was a common commitment to means, it became manifest in absolute trust in the expert. Science, which was broadly defined to embrace both technology and medicine, provided the inspiration and authority for reform. Supposedly objective, rational, and gender-free, professional values were assumed to be informed not by narrow self-interest but by concern for social and democratic ends. It was the expert who would interpret the benefits of disinterested science for the social good. Scientific professions allegedly forswore personal gain, and for this reason professionals were particularly conspicuous in the reform movement—especially those in what we now call the “helping” professions—physicians, social workers, educators. The professional was expected to be pledged to an ideal of unselfish service and gained considerable social approbation on this account. In these years of liberal activism, the twin ideals of altruism and efficiency served to validate both private and public goals.28
The reorganization of medicine was part of the liberal campaign to rationalize the professions for the larger social good. Moreover, the ideology of reform meshed effortlessly with the goals of the nineteenth-century movement to train women in medicine. In the nineteenth century, women physicians had pleaded for equal opportunities in medical education on the grounds that they would bring science to bear on the daily life of the family. The woman physician had a right to exist because she benefited society, and more specifically, the large majority of women who would stay at home to raise their children. It was understood that the woman physician would always remain exceptional, but supporters claimed for her a more assiduous interest in preventive medicine, a natural ability to work with women and children, and a humanizing effect on the profession.
When progressivism made women physicians’ work in the form of social medicine legitimate in the early decades of the twentieth century, they achieved a cultural validation that they had never experienced before. Their response was to throw themselves nthusiastically into every aspect of progressive reform that touched even remotely on questions that could be claimed as their own area of expertise. Far from being passive beneficiaries of the new liberalism, women physicians helped to shape the tone and content of the medical profession’s own progressivism, while playing a significant role in linking medical efforts at reform with social feminism.
In 1910 President Lenna L. Meanes of the State Society of Iowa Medical Women made this connection explicit in her annual address. Agreeing with a woman writer that the reform movement ought to be dubbed “The Woman’s War,” and its ensign should be a “Babe in Arms,” she reminded her audience that “the cause of the child has been placed foremost by philanthropy, education, science, Theodore Roosevelt and Judge Lindsay.” Women physicians must be at the forefront of reform programs. “The optimism of today,” Dr. Meanes concluded, “is a wide-awake, hardworking, systematic, scientific kind of optimism. It is based upon many statistics, and leaves little to chance, and it is transforming the dreams of a few years ago into very substantial fact.”29
Women physicians’ participation in public-health activity was reminiscent of an older tradition of reform broadly conceived, which was characteristic of the last two decades of the nineteenth century. When the American Public Health Association was founded in 1873, it drew its membership from a wide variety of persons with diverse lay and professional interests. Although physicians took the lead in the organization, they shared with lay members the contemporary belief in the strong relationship between good health and a clean physical and social environment. Even those individuals who were willing to incorporate into their thinking the new theories about germs did so without relinquishing their conviction that health problems demanded the generalized attention of a wide number of groups: physicians, engineers, female reformers, teachers, and educators.
As public health was professionalized in the decades after 1900, the triumph of scientific medicine transformed the movement into a more narrow group of specially interested experts whose well-defined and clearly articulated theory concentrated on the specific agents of disease. This development sharply reduced the scope of professional concern. No longer advocating broad programs of sanitation and slum clearance, these new experts reflected narrower goals more specifically influenced by bacteriological medicine. The chief concern became the control of communicable diseases through public programs of immunization and treatment. Gone was the luxury of long discussions concerning the social and environmental factors in susceptibility; the language was now the language of specific etiology. 30
Though individual women physicians also participated in this transition, as a group women doctors were much slower to respond to the “modern” approach to public health. Their participation in social medicine was so varied and so extensive that the subject demands more attention than will be given here. Though after 1900 they remained roughly 5 percent of the profession, their visibility in various progressive programs for health reform measured far out of proportion to their actual numbers. In terms of numbers only, men would continue to dominate the field of public health, but women physicians’ concerns were wide-ranging: passing wages and hours legislation, developing industrial medicine, correcting health and housing conditions in the slums, popularizing sex education and social hygiene, teaching preventive medicine and public health, preventing tuberculosis and venereal disease, improving education of midwives and obstetricians, guaranteeing clean milk and pure water, revising the system of vital statistics, promoting eugenics, amending scientifically the treatment of female delinquency, and securing school health inspection.
Women physicians claimed preventive medicine as their province well before it became fashionable in the years after 1900, and their own tradition of public-health education in the form of lecturing had its roots in the health-reform movement before the Civil War. The names of women physicians, such as Helen C. Putnam, Eliza Mosher, Mary Wood-Allen, Alice Hamilton, Mary Putnam Jacobi, Bertha Van Hoosen, Rachelle Yarros, Josephine Baker, and Annie S. Daniel are conspicuous in the early public health movement, the settlement movement, and the Association for the Study and Prevention of Infant Mortality, as well as social-purity crusades, tuberculosis-prevention campaigns, antiprostitution and antivenereal disease activity, and other lay and quasi-professional meliorist efforts which had their origins in the last two decades of the nineteenth century.
More than half of the papers delivered at the alumnae meetings of the Woman’s Medical College of Pennsylvania in these years were explorations of public-health problems and women’s role in particular. In 1901 the Woman’s Medical Journal established a monthly department under the general editorship of Dr. Jennie McGowan entitled “State Medicine and Hygiene” which was devoted to keeping readers current on the problems and progress of social medicine. The pages of the Journal from the 1890s onward, in contrast to the Journal of the American Medical Association, are full with public-health concerns which formed part of the reform agenda.31
Women physicians also dominated public-health education out of proportion to their numbers. This was a part of medicine that they claimed as their own special province and that male physicians generally were happy to concede to them. This activity also linked women physicians to social feminism and allowed them to maintain strong connections to the women’s movement. In 1905, for example, an editorial in the Woman’s Medical Journal appealed to the profession and to the AMA to support programs in public health and preventive medicine. We are “pitiably provincial in our public efforts,” the Journal complained, criticizing physicians for their neglect. Four years later Rosalie Slaughter Morton, a New York surgeon and an active member of the Women’s Medical Association of New York, brought the issue before the AMA. Attending the annual meeting in 1909, she was struck by an implicit consistency in the numerous papers on acute diseases given at the conference:
In papers on tuberculosis and cancer medical men lamented the prevalent ignorance of the public regarding early symptoms which, as a result, reached the stage of futility before patients recognized them. Pneumonia, nephritis, gastritis and other acutely serious diseases developed, owing to lack of knowledge about the care of common colds, diet and other easily corrected health faults, and often progressed to almost incurable states before coming under professional care. When there was inflammation of eyes or ears, obviousness usually gained early attention, but most insidious diseases grew unnoticed or willfully neglected for years.32
Attending the section on Public Health, Morton observed that similar regrets were expressed by the assembly, but no one bothered to propose remedies for the situation. Impatient and frustrated, Morton rose to introduce a resolution which read,
Whereas the American Medical Association ... stands committed to the education of the public with respect to the nature and prevention of disease, resolved, that the women physicians, members of the American Medical Association, take the initiative individually in their respective associations in the organization of educational committees to act through women’s clubs, mothers’ associations, and other similar bodies for the dissemination of accurate information touching these subjects among the people, and that they be requested to submit to the House of Delegates a yearly report of such work, and elect from among their number a committee to take charge of the same.“33
Explaining her resolution to the gathering in the midst of “masculine chuckles,” she observed that she considered it “odd” that “men physicians were just waking up to preventive medicine, while women doctors had for fifty years been stressing the importance of educating mothers in the care of children’s health, in pre-natal care of mothers, etc.” A sympathetic male colleague added that women physicians “as members of church and lay women’s organizations” were constantly being asked to lecture publicly on health issues, while “medical men almost always refused to make similar addresses,” claiming that it was undignified or that they did not have time. Morton herself believed that men’s orientation emphasized acute care and that they gave little thought to anything else. Dr. William Bumby, a state health officer from Texas, rose to confirm her observations. Recounting his own disappointment with the private ractitioners of his-area in mustering support for a legal measure guaranteeing milk pasteurization and the testing of cows—“they all replied they were too busy to be bothered with such details”-he finally appealed to the women’s clubs. “The result was electrifying,” Bumby recalled. “They were delighted to help regulate a cow instead of reading Emerson to one another.” With women’s help, Bumby concluded, legal action swiftly ensued.34
Still, objections were raised to Morton’s resolution. Some men worried that public lectures could be considered a form of self-advertisement, something that violated medical ethics. A few complained that if lectures on preventive medicine were successful, doctors’ incomes would be reduced as people ceased to consult them as often. Still others remained suspicious of the idea of professionals cooperating so closely with lay women. Four years later at a meeting of the Woman’s Medical College of Pennsylvania alumnae, Dr. Rachelle Yarros testified to a similar reaction when she recalled that when she first came to Chicago at the turn of the century, “my men colleagues in medicine rather resented my taking part in club work. They did not think it was worth my while.” But a decade later, their attitude had changed, “because, whenever they are interested in any health legislation or health education, they ask their wives and friends to bring these topics before the women’s clubs, feeling that this will assure their success.”35
After a protracted debate Morton’s resolution gained endorsement by the AMA in 1909, and she was appointed to organize their Public Health Education Committee. Joining her in the planning were Sarah Adamson Dolley, Evelyn Garrigue, and Alice Gregory of New York; Lillian H. South of Bowling Green, Kentucky ; Sara Craig Buckley of Chicago; Rose Talbot Bullard of Los Angeles; Annie Lee Hamilton of Boston; Margaret Holliday of Austin, Texas; and Laura L. Leibhardt of Denver. Within a year a ten-member central committee consisting of six women and four men and chaired by Eleanor S. Everhard of Dayton coordinated the work of three subcommittees—on affiliated public health work, medical literature, and cooperation, respectively—and kept in contact with 42 state chairpersons, 270 county chairpersons, and 6 city secretaries, all of them women physicians. Letters were written to another six thousand women physicians, and authoritative lecture series by medical men and women were soon launched under the auspices of state and county medical societies in thirty-three states. At the next annual meeting of the American Medical Association the committee presented a 136-page printed report in book form to every member of the House of Delegates, “giving condensed details of subjects, by whom presented, attendance at lectures, direct and indirect results, in every state in the Union and also in Alaska, Hawaii and Panama.”36
The activities of the Public Health Education Committee continued a long-standing tradition of cooperation between women physicians, clubwomen and other feminists. From the turn of the century on, the Women’s Medical Journal called for a closer relationship between the clubs and women physicians.37 Women doctors were urged to join their local clubs and influence the direction of their programs toward the preservation of public health through teaching and leadership. Typically, they displayed a lively interest in euthenics—the idea of making housekeeping more scientific.38 After the organization of the AMA Committee in 1909, they formed hygiene committees in local clubs which then cooperated with medical societies and other public welfare groups to sponsor lectures.
For example, one of the most successful and well-publicized lecture series was held between January and April 1910 at the New York Academy of Medicine. It was sponsored jointly by the Public Health Education Committee of the Medical Society of the City of New York and the Hygiene Committee of the New York Federation of Women’s Clubs. Lectures by two male and two female physicians covered a wide range of topics, including fresh air treatment in the school, the nursery and the sick-room, wholesome food and diet, feeding school children, industrial diseases, hook-worm, malaria and yellow fever, and dental care. A similar program sponsored by the Kings County Society took place in Brooklyn the following year. Between a third and a half of the speakers were women.39
The work of California women physicians with local women’s groups was particularly remarkable. They lectured endlessly on the hygiene of young girls, tuberculosis, school hygiene, food and milk sanitation, and nervousness in children, preparing book lists and leading study groups. They organized pure milk campaigns, “clean up” days in local towns, and pure food and drug activity. In the San Joaquin Valley, Dr. Mary Butin formed visiting committees that inspected local dairies, and convinced her club to sponsor a district nurse. Dr. Rose Bullard, the chairperson of public health for the Los Angeles district, maintained a speakers’ bureau of women physicians and hired a nurse on behalf of her club who “located every tuberculous individual” in the district to see that “certain precautions” were carried out.40
Rosalie Slaughter Morton summarized women physicians’ various contacts with the lay women’s movement in her autobiography:
Their [the General Federation of Women’s Clubs] national organization numbered nine hundred thousand intelligent, public-spirited and wealthy women who molded public opinion toward protecting the health of American citizens. We were in touch with all educational and philanthropic agencies through the United Charities Association. Our work became of service to the hundred and ninety-three thousand women in the local and national Young Women’s Christian Associations through the direct cooperation of the national secretary. We likewise functioned through the Mothers’ Clubs, of which there were sixty in New York City alone; with the State Assemblies of Mothers and the National Congress of Mothers; with the National and International Council of Women, the National Society of Sanitary Prophylaxis, the Ethical-Social League and with many other organizations. We learned what efforts toward preventive medicine were already being made in various states in order to be most helpful and not duplicate services. Pamphlets and lists of books were given general distribution.41
The Public Health Education Committee of the AMA remained in existence for four years, when it was superseded by a new body, the Council on Health and Public Instruction, which ultimately published the AMA’s popular magazine Hygeia. Morris Fishbein, one-time president of the AMA and its historian, does not even bother to mention the Public Health Education Committee in his massive history of the organization, and he describes the primary purpose of the AMA Council on Health as one of “public relations. It conceived its principal commission to be the development of public confidence in the purposes and work of the American Medical Association and of the medical profession.”42
Rosalie Slaughter Morton also understood that one aspect of women physicians’ public-health work would be public relations for the profession. Like Fishbein and the other members of the AMA she worried that it was often the women’s clubs that fell victim to “antivivisectionists and other sobbing cliques” and she understood that women physicians—both as scientific experts and as “members of these clubs”—were in a position to refute medical quackery. She believed, in fact, that it was primarily the accomplishments of women physicians in the area of public instruction that eased the relationship between the profession and the lay public. “It would have been a serious reflection upon our profession at this psychological time,” she wrote, “if we had not promptly educated the public to a thorough appreciation of the doctor’s role as protector of health of the community.... We credited the American Medical Association with all our gratuitous work in order to foster an acceptance of its altruistic concern for the health of women and their children.” Similarly, Dr. Lena K. Sadler, chairperson of the AMWA Public Health Committee, highly valued work with the women’s clubs for the same reason. “Why not,” she asked, “intelligently guide their interest and enthusiasm along the proper channels by co-operating with them in such a way as to bring about a closer understanding between them and organized medicine?” Women doctors “as women” understood their viewpoint, while “as physicians” sympathized “with the attitude of organized medicine.”43
Women physicians, however, valued public-health instruction not solely for what it could accomplish in positive professional public relations. They were reformers in their belief that their role in such educational activity would have even greater social significance by changing the living habits of most Americans. Thus, when the Council on Health and Public Instruction was established with no women members, women doctors perpetuated their educational activities with the women’s clubs through other organizations. The Woman’s Medical College of Pennsylvania, for example, offered courses of popular lectures on various health topics given by distinguished members of the faculty.44 A number of women physicians were active leaders in the American Social Hygiene Association and worked closely with the YWCA. Throughout the 1920s the American Medical Women’s Association, through its own Public Health Committee, continued to maintain strong ties with local women’s groups. Argued President Grace Kimball in 1923:
When you realize that this association is affiliated through the federation of clubs in America with eleven million organized women, you will see the duty and the opportunity of our medical women to act as authorities on health and medical information to these great bodies of lay women.... We must get busy.45
The AMWA yearly sent its representative to the meetings of the General Federation of Women’s Clubs. It also attempted to coordinate its activities with the AMA Council on Health and Public Instruction ; the Association of Women in Public Health, founded in 1920; the Woman’s Advisory Council of the United States Public Health Service, a group first appointed in 1922 and consisting of three prominent women physicians; the Woman’s Joint Congressional Committee; and the Women’s Foundation for Health, founded in 1922 and consisting of lay and medical women who worked closely with the AMWA’s own Public Health Committee. 46
Directly related to their work in public health education was women physicians’ active participation in a variety of other social hygiene programs. “The question of social hygiene,” remarked Dr. Prince Morrow in 1910, “is a woman’s question.”47 Women physicians took Morrow’s statement to heart. The Woman’s Medical Association of New York City, to choose one of many examples, organized a standing committee on social hygiene in 1907. Believing that the subject held special concern for women physicians because of their expertise, the group played an active role in the promotion of progressive social hygiene measures on the state level. They investigated the management of women offenders before magistrate courts, looked into the conditions under which such offenders were placed when convicted and sentenced, and concerned themselves with provisions for educational training and rehabilitation. They studied state laws governing sexuality and methods of police enforcement. They actively engaged in promoting and encouraging progressive legislation whenever possible, making personal appeals by letter to lawmakers in Albany on behalf of the Association and of women physicians in general. 48
Emily Dunning Barringer remembered the impact of her first visits to women offenders in the city’s jails. She believed the experience “influenced my subsequent medical activities more than any others.” Particularly vivid was her memory of the way male police approached these women with “disgust and disdain,” in spite of the fact that “the prostitute ... would not be in her unfortunate position if the men of the community had not put her there for their own gratification.” It was then that she understood “how basically unfair the relation between the sexes was, and how much there was to be done in improving the condition of our woman criminals.” Barringer later joined the National Prison Association and worked for a time among the female wards of New York City’s correctional institutions
Each year the Woman’s Medical Association of New York City sponsored a symposium for lay and medical professionals on the subject of social hygiene. Under their auspices, progressive reformers like Florence Kelley of the National Consumer’s League, Felix Adler of the Ethical Culture Society, Katherine Bement Davis of the Bedford Reformatory, Frank Moss, assistant district attorney for New York City, and Dr. Prince A. Morrow, founder of the American Society of Sanitary and Moral Prophylaxis, were provided with a public forum consisting of lay and medical personnel for the exchange of information.49
Directly related to women doctors’ interest in social hygiene was their promotion of the teaching of hygiene and physiology in the public schools. Helen C. Putnam, for example, devoted a good deal of her career to encouraging such teaching by professionals, preferably physicians. Putnam was a graduate of the Woman’s Medical College of Pennsylvania in 1889, a cofounder, along with Dr. Abraham Jacobi, of the American Child Health Association, and former president of the American Academy of Medicine, a progressive group of doctors interested in “medical sociology.” She chaired the Academy’s committee on the teaching of school hygiene and represented the United States at a number of international conferences on the subject. Her articles on child hygiene, as well as those of a number of other women physicians, often appeared in the Woman’s Medical Journal.50
Although Putnam was willing to see such teaching be done by trained professionals in fields other than medicine, some women physicians believed the work should be reserved exclusively for women doctors. In 1920 Lilian Welsh, also active in the cause, told the alumnae of the Woman’s Medical College of her faith in the special benefits of their particular expertise. “I think teachers of hygiene should be doctors of medicine,” she concluded, after completing a long discussion of the social benefits of such programs. “I have watched it taught from the physical training department. I have watched it taught from the so-called domestic science department, and the very sure background is that which comes from those who have medical knowledge. Here is the place, a specified place, for the women medically trained, who bear today the degree of doctor.”51
In addition to their interest in school curricula, a number of women physicians, like Dr. Valeria Parker, Dr. Rachelle Yarros, Dr. Anna L. Brown, and Dr. Mabel Ulrich, had strong connections with the Bureau of Social Hygiene, spending time primarily in antivenereal disease and anti-prostitution work. The Social Morality Committee of the YWCA, founded in 1913, also maintained a staff of women physician lecturers who taught sex hygiene primarily in the normal schools.
American entry into World War I stepped up social hygiene activity concerned specifically with the problems of venereal disease and prostitution. Katherine Bement Davis of the Bedford Hills Reformatory was appointed to head the social hygiene division of the Commission on Training Camp Activities of the War Department and, though the Army refused to commission women as medical officers, the government welcomed their participation as social hygiene lecturers. Dr. Anna L. Brown of the War Work Council of the YWCA made its Lecture Bureau available to the government, and over a hundred women doctors participated in sex education and antivenereal disease programs, utilizing Davis’s harshly moralistic film “The End of the Road” to illustrate to the young women of the country “the importance of physical, mental and moral hygiene.”52
Women physicians working in social hygiene demonstrated a wide range of attitudes toward the changes in social and sexual mores that took place in the early decades of the twentieth century. Just as it is impossible to generalize in any comprehensive way about their approach to therapeutical issues, it is difficult to demonstrate that there was any single collective answer among women doctors to questions involving sexual morality. Many of them shared the beliefs of conservative social hygienists and social-purity feminists who attacked the double standard and sought to impose a single, female standard of chastity on American society. Along with other women activists, they worked to gain social and legal controls over sexuality, emphasized the importance of con-sensual sex for women in marriage, and fought against prostitution and its related evils. Like Dr. Inez Philbrick of Lincoln, Nebraska, many perceived an increase in venereal disease and attributed it to the “enormous exaggeration of the sex instinct” resulting from the economic dependence of women on men, and believed that women physicians had an important role to play in reversing such dangerous trends. For these women, the sexual drive and initiative were primarily male, and thus they viewed the prostitute either as a total victim of male lust or as a sexual delinquent. “Marital, as well as social continence, is a crying need of the hour,” wrote Philbrick in the Women’s Medical Journal. “And the medical profession must take the lion’s share of the responsibility in pressing for these values, alongside the church and the press.”53
A conservative approach to sexuality generally led some women physicians to support the eugenics movement. A number of them developed hereditarian ideas while serving as school inspectors or resident physicians in institutions or reformatories. The increased emphasis of many social thinkers on heredity and biology gave physicians a new authority in these institutions, and women physicians gained an even greater voice because of their presumed connection with family life, other women, and children. As the Woman’s Medical Journal observed in 1907, “Teachers have naturally turned to medical science for help in the solution of the many problems presented, consequently the pedagogic and medical mind are beginning to look at the growing child through each other’s eyes with mutual benefit to the two sciences, and we hope with benefit to the present-day child. ”54
Katherine Bement Davis, a social worker who directed the Bedford Reformatory in New York, testified to the increased use of physicians in reformatory work in a paper entitled “Delinquency and the Medical Profession” that she gave to the alumnae of the Woman’s Medical College of Pennsylvania in 1917. Admitting that in the beginning of her career she believed that she needed only a staff of good teachers, she gradually had come to see that the problem of delinquency was more one of inheritance and disease. “Now the pendulum has swung so far,” she declared, “that the members of the medical profession have first place on our staff.”55
Similarly, Helen MacMurchy, Inspector of the Feeble Minded for the Department of Education in Ontario, Canada, argued in 1915 that medical expertise had become essential in the proper handling of delinquency. “Sometimes,” she wrote in “The Doctor and the Children’s Court,”
one wonders whether the fault is with the doctor or with the public. Has the doctor forgotten what he or she can do for the public, or has the public no idea what the doctor can do for every person and for every institution? The home, the school, the church, and the court struggle along with problems which only the doctor can solve. They do not seem to realize that the doctor has a key that will open the doors and bars against which they hopelessly beat themselves in an endeavor to open them. One can not sit in a children’s court without having this sad truth painfully beaten in upon mind and heart. The endless procession passes through faster or slower according to the skill, the insight and the ideals of the judge on the bench. About one-third or more of these boys and girls really belong to the doctor.56
For many women physicians, delinquency, especially among girls, usually meant some form of sexual misbehavior. Some reformers viewed eugenics as a solution that offered a chance to remedy problems that were being diagnosed increasingly as biologically induced. The American Medical Women’s Association established a Committee on Race Betterment, for example, and occasionally debated the question of sterilizing criminals and the feeble-minded. A few members supported such measures, though the association never took a public stand on the issue. Numerous articles in the Woman’s Medical Journal discussed the connection between eugenics and social reform.
Elizabeth Thompson Smart, for example, medical examiner for the mentally defective in the New York City Department of Education, published several studies declaring feeble-minded children a “social menace.” Most of them, she wrote,
are, or may become, to a more or less degree sexual perverts. The sex instinct is very strong in very many of the older boys and girls. The school law protects them up to the age of sixteen years; we can do everything possible for them to better their condition up to that age, with the consent of the parents, of course, but beyond that we may not go. What is to become of this vast army of menacing humanity ? Shall we, as medical women and men, sit calmly by with folded hands and permit the outrages of illegitimacy and prostitution to go on in the midst of human beings who do not know the meaning of their acts? Shall we sit by while some of these mental weaklings are granted licence to marry and reproduce their kind—or worse? This is a burning question brought home daily, I might say hourly, to the physician whose duty it is to examine and prescribe for them.57
In the eyes of some reformers, eugenics was a rational means of improving the social environment. But well-meaning progressivism could occasionally cross the line and become the elitist racism of the ruling class. In this, too, some women physicians differed little from other liberal reformers. In justifying their own central role in raising the question of positive eugenics Kate Campbell Hurd-Mead warned:
We are confronted today by problems in a measure unknown a generation ago. Instead of the sturdy Irish and Swedish immigrants of the 70’s, we have the underfed, undereducated and nervously irritable Italians, narrow chested neurotic Jews, and half-famished Russians whose suppressed energy may rise in anarchy as soon as it feels the unrestrained freedom of our country. From the children of such parents we must raise a nation strong in mind and body.58
Fears of “race suicide” and an inordinate respect for motherhood led many of these same women physicians to reject artificial birth control and to sanction only sexual continence for the sake of a woman’s health. Eliza Mosher, senior editor of the Medical Woman’s Journal and an outspoken critic of the American Birth Control League, argued that contraception was “a menace to the population of America fifty years from now,” and would “destroy in girls and young women the maternal instinct.” She linked the availability of artificial contraceptives with increased sexual promiscuity among the young, suggesting that “men no longer feel” the “urge to Marriage that they formerly did ...” because “they are able to gain all the sexual pleasure they desire with less expense and in safer companionship.”59
Similarly, Dr. Mary L. Fitzpatrick of Milwaukee, writing in 1916, told Julia Lathrop, head of the Children’s Bureau:
Experience has taught me that what women do need to realize is this, that the bearing and rearing of as many healthy children as she can, and thereby do justice to both herself and her offspring is the most satisfactory in after life, the most worth-while, and in comparison with it all the occupations of men are dull and stale and pale into insignificance. To rear strong children and to train them so that they become useful men and woman—what more stimulating or inspiring brain work could women desire?60
While some women physicians rejected female sexuality, favoring legal measures to regulate the sexual behavior of the community at large, and flirted with eugenics to create a race less sexually “perverse,” others joined a minority of their male colleagues in welcoming the changes in sexual mores that recognized in female sexual expression a positive personal and social good. These clinicians, often gynecologists, witnessed firsthand the vast misery in marriage caused by sexual ignorance, and entertained the notion that a more satisfying physical admustment would lead to happy, more stable marriages—an ultimate guarantee of social stability. Rather than blame the rising divorce rate on the decline in sexual standards, they preferred instead to see it as a symptom, among other things, of improper sex education.61
Mary E. Bates, for example, a graduate of the Woman’s Medical College in Chicago in 1881 and one of the earliest women to intern at Cook County Hospital, owned a flourishing gynecological practice in Denver. In an article on phimosis in the female, published in the Woman’s Medical Journal in 1906, she berated male physicians for not taking sufficient interest in physical handicaps that might hamper women from experiencing sexual pleasure. “Sexual undevelopment, indifference and incompetence,” she believed, “is one of the most frequent causes of the ‘failure of marriage.’ ” Couples that were sexually “mated” were usually happy, while those that were unhappy were often “sexually mismated.” Bates believed that medical silence on the sex psychology of patients was a “mockery of ‘modesty.’ ” She urged women physicians to bring their expertise to bear on these problems. The potential for easing the difficulties of their patients was boundless. The woman physician, she suggested, must be a sex therapist.
A woman physician ... should carry the higher thought that the woman physician is the response to the inherent need of her sex kind for some one to comprehend her sex construction; to appreciate her sex limitations and deviations; to realize her social sex conditions, her physical, mental, and moral sex responsibilities; some one to minister to her mind, her soul as well as to her flesh; and to point the way to woman’s sex freedom and sex self-respect.62
Another woman physician who displayed a long-standing interest in female sexuality was Clelia Mosher, a graduate of Johns Hopkins. In the 1890s, under the influence of her good friend, the sociologist Mary Roberts Smith, she began a survey of sexual behavior and attitudes first, among members of the Mother’s Club of Madison, Wisconsin, and later among faculty wives and coeds at Stanford University. Although she never published the results, which revealed her subjects to be cautiously positive about their own sexuality, her questionnaire suggests that she was extremely sensitive to changing sexual mores among women, and wished to understand better the importance of sexuality to stable marriages.63
There was also an important group of women physicians who were active in the birth-control movement, and many of them, too, viewed artificial contraception as a means to foster positive sexual relations in order to preserve marital happiness. Some, like Rachelle Yarros, also hoped that contraceptive information would ease the burdens of working-class women and preserve the health of all women by allowing them to space their children more carefully. Others, like Lydia Allen DeVilbiss, were less sympathetic with poor immigrants and blacks, and intended contraceptive clinics primarily to control the alarmingly high fertility of “inferior” races. But for the most part, women physicians participated in the early birth-control movement—directing many of the birth-control clinics that sprung up in the 1920s—because they viewed “Constructive Birth Control” as another means of rationalizing family relationships and improving the quality of life for women, men, and children. Explained Rachelle Yarros, who ran her own clinic in Chicago:
Constructive Birth Control must concern itself frankly with marital happiness.... Our policy should be to dispel ignorance of men and women in sex matters, to teach them frankly and earnestly how to retain and foster love.... We must teach them that sex gratification in moderation plays a very important part in life, apart from the rearing of a family, because it is necessary to intimacy and tender affection between husband and wife.... A fundamental change in the mental attitude of men and women towards the sex relationship can only be brought about through the training of the individual from earliest youth in physiological science, ideals and standards of conduct. By overcoming our own inhibitions and clearly defining our own ideals we may become truly helpful in training the next generation.64
The establishment of the Children’s Bureau in 1912 and later the passage of the Sheppard-Towner Act, intended to help reduce infant and maternal mortality, increased women physicians’ opportunities to do the kind of public-health fieldwork at which they had become particularly adept. The Children’s Bureau underscored reformers’ concern for the child, and women physicians hailed the new agency as a “great step forward” in preventive medicine. They hoped and expected that women physicians would be integral to its work. “The medical woman,” speculated the Woman’s Medical Journal, would be of special value by virtue of her “inherent motherhood, together with the quick perceptions and keen discernment incident to her professional training.” Again the argument ran that the medical woman could combine rational, scientific, and professional values with tenderness, sympathy, and “infinite tact.”65
Even before the Bureau got under way women doctors pioneered in the work that would ultimately be identified with it. One of the earliest of these pioneers was Josephine Baker, whose accomplishments in New York City provided a model for later Children’s Bureau programs. In the early 1900s she had opened a private practice with another woman physician. To supplement her income, she became an inspector for the city health department. She saw a good deal of departmental corruption, but after 1902 when Seth Low became New York City’s mayor, a general house cleaning occurred and Baker began working with Dr. Walter Bensel, an energetic chief who was committed to making his department an instrument of social change. Soon Baker was appointed his assistant. In 1908 the Department created the first Division of Child Hygiene in the country, an agency designated specifically to design programs in preventive medicine, and Baker was appointed the chief.66
From then on, Baker published sophisticated analyses in the Woman’s Medical Journal of the successes and failures of the Division of Child Hygiene. Such reports inspired physicians—many of them women—in other cities across the country to imitate her methods and goals. “Communities of any size,” wrote Baker in one of her earliest articles, “when confronted with the problems of poverty, congested living quarters, ignorance and influx of alien races have found that in order to assure their future well being they must protect the health of the children. In public health movements proper guidance and instruction are essential. Municipalities have found that they must assume this function,” she continued, “and in no other line is the need more imperative and the results of more importance in their bearing on the future national progress than in the broad, comprehensive, and consecutive care of the health of children.”67
One of the first concerns of the new division was the legal regulation of midwives. In New York City in 1910, midwives managed over 40 percent of all births, a situation dictated largely by the cultural traditions of its large immigrant population. Unlike the majority of male physicians and even many women doctors who disapproved of midwives, Baker insisted that the employment of trained midwives was “an established necessity.” “The doctors,” Baker wrote in her autobiography, “were never able to understand the sort of people we had to deal with. If deprived of midwives, these [immigrant] women would rather have amateur assistance from the janitor’s wife or the woman across the hall than to submit to this outlandish American custom of having in a male doctor for a confinement.”68
Using what Baker liked to term “our mother-wit,” her bureau developed ingenious methods for supervising midwives already in practice, while weeding out the incompetent. In 1911, partly as a result of Baker’s support, a school for midwives was founded at Bellevue Hospital. From then on the Bureau refused to license midwives who were not graduates of either this school or a European equivalent. The six-month Bellevue course was under city control and was offered free to competent applicants. Baker believed that its graduates “knew more about delivering babies than three-quarters of the recently graduated internes entering on medical practice.”69 Though the properly trained obstetrical specialist was “of course the best possible person to bring a child into the world,” Baker understood that obstetricians were often too expensive for the modest household. Moreover, specialization in obstetrics still carried with it the stigma of low status and fewer financial rewards than other branches of medicine, while few who trained as general practitioners received adequate instruction in childbirth in their four years of medical school. For Baker the experienced and well-supervised midwife remained the most practical solution.
Baker collected statistics that bore out her hypothesis. In the first year of the regulatory program, for example, eighty-four deaths from puerperal septicemia were reported. Investigation revealed that only twenty-two of these occurred under the supervision of a midwife, while sixty of the women who died were being treated entirely by physicians. In the next few years, Baker collected and published figures which proved the maternal mortality rate to be higher among mothers delivered in hospitals by doctors than among women attended in their homes by a midwife.
Her claims often caused strained relations with her professional colleagues. She remembered one “hot discussion” at the New York Academy of Medicine soon after one of her articles was published. “I had a very bad hour indeed,” she recalled,
sitting at an Academy meeting as the target of all kinds of pointed remarks—they did not exactly call me a liar, but they skirted around it much too close for comfort. Then, to prove their point, they started an investigation of their own. That was my innings. In preparing my figures I had been absurdly careful to make them as unfavorable as possible to my point of view. If a midwife had so much as walked into the room where a prospective mother was in bed, her death would be placed to the discredit of the midwife, even if it had occurred while the case was under the doctor’s care. Since the Academy did not go into these details quite so carefully, their figures, when they were finally compiled, were even more favorable to the midwives than mine.70
As head of the Division of Child Hygiene, Baker shaped policy in her department according to the tenets of progressive health reform. Once the wrinkles in the program regulating midwives were smoothed over, she turned to other things: the education of mothers in the care of babies, a systematic inspection of all institutions involved in the care of dependent children, the comprehensive monitoring of child health in the schools through the control and elimination of contagious disease, the detection and correction of noncontagious physical defects, and controlling the worst abuses of child labor through the issuance of employment certificates to children between the ages of 14 and 16 years old.71
The Federal Children’s Bureau elaborated and supplemented the kind of work women like Josephine Baker were doing in cities and states across the country. In the first year of the Bureau’s existence it published a birth registration report, a survey of baby-saving campaigns, a pamphlet on prenatal care, one on infant care, a study of New Zealand’s infant-saving techniques, a report on laws relating to mothers’ pensions in the United States, Denmark, and New Zealand and an infant mortality study of Johnstown, Pennsylvania. In later years, nine more infant mortality studies were completed in a number of other communities.72
The Children’s Bureau was distinctly a female agency, and like no other in the federal government. It was female voluntarism, in the form of pressure groups and lobbying, that helped create the Children’s Bureau in the first place. Once organized, the Bureau imitated on a national scale the techniques of the settlement house. Much of the agency’s success in the progressive period can be attributed to its ability to continue a close relationship with female voluntary organizations and muster their help in its work. In its National Baby Week Campaigns, for example, it received the cooperation and enthusiastic support of local women’s clubs; groups of unpaid volunteers from these organizations worked all over the country to help the Bureau gather information for its studies. Clubwomen prepared personal reports for the Bureau about their findings. Wrote Alice Kimball, a Rhode Island woman’s club member who participated in its massive birth registration campaign, “I found my investigating extremely interesting, and instructive, as well. I feel now that I know a little more about the where if not the how ‘the other half lives.’ ”73
As head of the Children’s Bureau, Julia Lathrop attempted to preserve for a national agency the personal touch of the settlement house. The thousands of letters written to the Bureau during this early period suggest that for many years she achieved this goal. The letters are quite remarkable for their personal tone, the confidence that a reply would be forthcoming, and what they reveal about the difficult lives of the women of the rural and urban poor. A frightened 15-year-old, for example, wrote Lathrop in 1919: “I will write to you and ask you some things a lady told me about you I am 15 years old I was married the 23rd of June it will soon be 3 months and I dont feel good I think there is something going to happen to me will you please send me information of what to do I never had a mother to tell me anything so please write me at once what to do.” From Chicago, a working mother explains, “I nursed my baby mornings and night at night time after working all day then nursing my child, every drop it swallowed it would throw it up, at the same time suffering the awfull tortures with my milk, pumping it and throwing it into the sink. while my baby starved and my husband refused to provide for us.”74
The letters were all answered personally, either by Lathrop or Mrs. Max West, an assistant who also wrote the Bureau’s publication, Infant Care. The agency developed widespread female professional contacts—in both rural and urban areas all over the country—who often visited the troubled letter writer, or took the time to guide her to the proper agencies in her area.
A number of women physicians were part of this network. Some were paid by the Bureau to be field workers, others volunteered their time. For example, a farm wife from Andrus, Wisconsin, wrote after reading the Bureau’s information on pre- and postnatal care: “Now if any of your advice covers what an ordinary farm wife can carry out I would like to have it. Most of the advice I have read says—Fruite in plenty a bath every morning—gentle exercise—coffe before dressing. music—pleasant surrounding now I have a perfectly fine husband and a loveing home but here is my day—get up at 5 a.m. hustle breakfast for 5. wash dishes help milk feed pigs clean up bakeing—scrubbing washing—(where is the gentle ex?) ... where could I have the time for a bath every morn?” Mrs. West answered this letter by urging the writer to contact Dr. Dorothy Reed Mendenhall, a Bureau physician and author of several of their pamphlets, who traversed Wisconsin as a University extension lecturer advising pregnant women on “care of themselves and their babies.”75
Another woman physician, Dr. Eleanor Mellen of Newton Highlands, Massachusetts, wrote to Lathrop:
Having retired from the active practice of my profession, I have recently agreed to act as the Health Editor for a syndicate of newspapers largely among the rural districts throughout the country. Very many letters are sent to me each week and among those arriving lately was this which I copy; “My Mother never told be about myself when I am sick and so I do not know what to do when I come sick. Will you please tell me? Also I wish you would tell me how I am to tell when I am going to come sick. If you will kindly answer these few questions I will be very grateful. Please put your answer in a plain envelop so no one else will know what it contains.”
The child had mailed the letter in a different town from the one which she gave as her address. Of course I have given her the assistance that she desired, but I am wondering if your department in any way meets the needs of such cases. Have you any free publications that would tell this girl and those like her what they ought to know about themselves and the life waiting for them? Or can you refer me to such? I say “free” because many of the people that I reach are pitifully poor and they could not spend even pennies without missing them somewhere else. That is why this work of mine was started. I shall be very glad for any assistance that your department may be able to give me for them.76
Lathrop had a keen sense of the difficult medical conditions in rural areas, and was committed to rural health reform from the beginning of her tenure. Here, too, women physicians, like Dorothy Reed Mendenhall, or Mary Bates of Denver, helped out by becoming itinerant agents for the Bureau. Probably no one, however, accomplished more in this area than Dr. Frances Sage Bradley, an early female graduate of Cornell, who settled in Atlanta, Georgia, and became one of the first specialists in rural medicine. Bradley believed that the neglect of America’s rural children threatened the future of the entire nation, and in 1916 she had her chance to publicize her cause. In that year the North Carolina Board of Health requested the Children’s Bureau to conduct a social-medical survey of the state, and Bradley, as the Bureau’s special agent, carried it out. To this day her report remains an exemplar of its time. She spent six months investigating the conditions of tenant farmers, studying the special hazards to childbirth and the health of growing children, exploring sanitation conditions in housing and work, and observing and reporting on the particularly difficult position of rural women. In 1921, when the Sheppard-Towner Act made available federal funds for extensive programs in the prevention of infant and maternal mortality, the state of Arkansas founded a Bureau of Child Hygiene and appointed Bradley its chief.77
Just as the Children’s Bureau can be characterized as the “women’s branch” of the federal government, the Sheppard-Towner Act of 1921 might be dubbed “women’s legislation.” Female reformers rightly viewed the act as an important victory—one of the first results of woman’s suffrage. It legitimized the activity of women physicians and lay health workers who, for almost two decades, had been working to improve the nation’s health and welfare through educative preventive medicine. Under the terms of the law, the government would provide states with matching funds to establish prenatal and child-health centers. Here female professionals could teach mothers personal hygiene, infant management, proper pre- and postnatal care, and family health. Sheppard-Towner was one of the first government acts to recognize the responsibility of the State for the health of its citizenry, and it pioneered in expanding the role of the federal government in preventive medicine.
The American Medical Association opposed the passage of the bill, and lobbied against it throughout the 1920s until it failed of renewal in 1929. The official position of the AMA endorsed the goals of the legislation—to upgrade obstetrical and pediatric care—but argued against the concept of federal aid as “unAmerican,” and objected to its being administered by the Children’s Bureau, a lay organization.78
Women physicians displayed none of the ambivalence toward the Sheppard-Towner Act that characterized so many of their male colleagues. The act seemed for them to be the fulfillment of years of agitation, and in many respects the attitudes of some of their most conservative male colleagues shocked them. Josephine Baker, for example, recalled a particularly unsettling encounter with the “short-sighted psychology of a certain type of doctor, when confronted with public health work” when she was called before a Congressional committee to testify on behalf of the bill: “This New England doctor,” she remembered:
actually got up and told the committee: “We oppose this bill because, if you are going to save the lives of all these women and children at public expense, what inducement will there be for young men to study medicine?” Senator Sheppard, the chairman, stiffened and leaned forward: “Perhaps I didn’t understand you correctly,” he said: “You surely don’t mean that you want women and children to die unnecessarily or live in constant danger of sickness so there will be something for young doctors to do?” “Why not?” said the New England doctor, who did at least have the courage to admit the issue: “That’s the will of God, isn’t it?”79
Baker understood that such thinking followed logically from the profession’s overemphasis on cure rather than prevention, and she had little patience with such shortsightedness. As for other women physicians, Sheppard-Towner dramatically increased their opportunities for employment. They flocked to staff the new clinics opened under the auspices of the act. By 1924, forty states were cooperating under its provisions, and the Medical Woman’s Journal hailed their accomplishments. In 1927 the Committee on Medical Opportunities for Women of the American Medical Women’s Association revealed that a total of forty women physicians were employed full-time and three part-time in positions created by the act. In addition, four women physicians worked in the Maternity and Infancy Division of the Children’s Bureau, a division directed by Martha May Eliot, professor of pediatrics at Yale Medical School. Sixteen of the forty states employed women physicians as directors, and an additional twelve employed them in a full-time capacity on the maternity and infancy staffs of the State Division of Public Health.80
Even in states where medical and lay opposition was so strong that state governments refused to participate, women physicians made serious efforts to devise programs that would be more acceptable. Lena K. Sadler, a member of the Public Health Committee of the AMWA, described the situation in her state to her fellow convention delegates in 1925:
I wish to say that the Sheppard-Towner Bill, fortunately or unfortunately is not functioning in the State of Illinois. When I accepted this chairmanship, I saw the hand writing on the wall, lady physicians, that it perhaps would not function in my State because almost unanimously the medical profession is set against it.
Sadler went on to say that once she had accepted this fact she organized similar programs to which the profession would not object. “Personally,” she concluded, “it is nothing to me, whether it functions or not, because I believe my record is behind me. For eighteen years I have preached preventative medicine all over the United States in the various Chatauquas. I believe in every educational feature of that Bill, but when organized medicine is against it in my state, I must do something with the clubs to take its place.”81
Sadler’s words underscore the fact that women doctors carried the tradition of what one historian has termed “social therapeutics” into the twentieth century. In a sense, they merely continued to do what they had always done, and for the first few decades of the century their work was sanctioned by a reformist ideology that considered the improved health and welfare of a modernizing nation the immediate concern of all enlightened professionals and men and women of science. Their continued optimism about their own future, at the very moment when significant barriers against women were being constructed in science and academe, and their own flexibility in the profession was being considerably narrowed by the transformation of modern medicine, can be puzzling if we do not realize how the ascendancy of liberal ideology validated their identity.82
It is certainly true that women physicians, because they were not as dependent on the university for employment after their training, had more autonomy than either women scientists or women in higher education. There existed a more varied market for their services. To “defeminize” medicine did not mean to rid the profession entirely of women, but merely to shunt them into “feminine preserves.” Moreover, brave women could still go into private practice. Nevertheless, the numbers of women in medicine increased at a slower pace even than those for the other two fields, and in spite of women physicians’ rhetoric about increasing opportunity, young women consistently chose other careers.
The numerous articles by women physicians in the first decades of the twentieth century that take it for granted that women would remain a minority within the profession also suggest that they themselves had not yet conceived of a time of real professional equality with men. Their optimism derived from the sense that they had fought and won access to the profession for a special minority. The idea that all women might somehow have jobs or careers, or that 50 percent of the profession should be female—indeed even the concept of balancing both family and career—these were visions of women’s options shared only by a few, while for most, such arrangements still lay well in the future. Some women physicians, indeed, were still questioning the propriety of marriage.83
Moreover, the “special treatment” that women physicians received for their public-health work could often be demeaning, although such an interpretation benefits from historical hindsight and was clearly not always noticed by women at the time. For example, an enthusiastic report about the activities of women doctors in San Diego given by the chairperson of the Organization Committee at the 1924 meeting of the American Medical Women’s Association boasted:
I want to give you, as one concrete example of the organization work.... In San Diego County there are just nine,—I think Dr. Towle of San Diego is here, and if I am wrong she can correct me,—nine medical women. Here is what they have accomplished. They are the pet organization of the San Diego Medical Society. The men are so proud of them and so fond of them that it beams out whenever they come in contact with them. They are given every help and every cooperation, and, the men, if I were to tell the truth I think the men let them do a whole lot of the good hard work and sit back and rejoice in the spontaneity and enthusiasm with which the Women’s Medical Society does a lot of their hard work. After four years of work the San Diego County Medical Women’s Association has taken over all the Chairmanships of the women’s organizations in welfare work, public health work, etc. It has backed and financed the Sheppard-Towner work in San Diego County. It discusses at its meeting every two weeks for luncheon and passes upon all welfare work done in all the women’s organizations. It has the cooperation of all the county and city health officers. It furnishes doctors, dentists and nurses for all the conferences of that very important society, the Parent Teachers Association, in that part of Southern California. It puts on child welfare conferences at the county fairs, in the different parts whenever they occur in the county. It has maintained centers in the schools in San Diego where conferences are held monthly. Last year they held about forty conferences and examined and reexamined over one thousand children. At each conference they have two general physicians, a specialist in eye, ear, nose and throat, a dentist and two nurses. Throughout the county in ten centers they have organized the Sheppard-Towner work. They have the full cooperation and backing of the county medical society and all organized medical groups. The standing of the women physicians has been wonderfully raised in the county, both in the profession and among the laity. 84
And yet, as much as they valued their role as the champions of social medicine, there was in their discourse an occasional uneasiness about the unequal and confining terms of the progressive bargain. It is not always easily detected, because, as we have seen, women physicians talked a good deal themselves about their unique social role. They were not as sensitive to the myriad forms of discrimination as later women would be, but occasionally they chafed against it, displaying hurt and anger when it became too blatant. It is apparent, for example, in their deep disappointment over the shabby treatment they received during World War I, when their desire to serve and prove themselves as professionals was blocked by the refusal of the federal government to commission them as medical officers. Their response was to join the American Medical Women’s Association, which kept up constant pressure on the government, and to work to fill positions left by the men who had been mobilized. In addition, they defiantly organized their own medical efforts overseas in the form of American Women’s Hospitals. Explained a distraught Mary Buchanan, president of the WMCP alumnae association in 1918:
We felt last summer, when Dr. Rosalie Morton was appointed Chairman of the Woman’s Committee, General Medicine Board, on the Council of National Defense, and picked a half-dozen other women from various parts of the country to serve with her, that before this women would be on the same footing as men in the M.R.C.; but alas! a year has passed and despite the time, money and energy these women have spent going to Washington, Dr. Franklin H. Martin and his male committee are still keeping them at arm’s length with words and arguments. It is enough to make anyone but Dr. Morton and Dr. Purnell give up in disgust. 85
Still, Buchanan continued, all the hospitals are asking for “women clinicians.... The cry is now not for positions for women in medicine, but medical women for positions.... When they ask bread, shall we give them a stone ... ? We need successors. We have the confidence of the community. The trail has been blazed for the woman doctor. Shall we allow it to be lost because there are none to “carry on?” Buchanan understood that the situation was only temporary, and history has proved her correct. After the war, it would be back to normal: ”With the return of the men from the C.M.C. of the A.E.F., many of our women will have to step gracefully out and give the men the positions they had before the war. This is not easy, but it is just—one more act of patriotism demanded, and no one will resent it any more than the other war sacrifices.”86
Women physicians’ discomfort with the growing inflexibility of their role as purveyors of public medicine can also be detected in their oversensitivity to well-meaning male physicians who occasionally echoed back to them their own ideology. Somehow, coming from a man, even a friend to women physicians, the ideas sounded vaguely sinister. A curious incident illustrating their beneath-the-surface resentment occurred at the graduation ceremonies of the Woman’s Medical College of Pennsylvania in 1915. Dr. Richard Cabot of Harvard Medical School, himself a passionately devoted pioneer of social medicine, gave the keynote address. In his appeal to women physicians to view themselves as peculiarly fitted for public-health specialties, he offended every woman present. In retrospect, it is remarkable that Cabot himself did not catch the full meaning of his own words. Asserting that the majority of women physicians—though equal to men in ability—were neither temperamentally nor physically adapted for the more strenuous branches of the profession and were often therefore “disappointed and dissatisfied,” he suggested that they should instead avoid general practice and research work in favor of social service, where they flourished and were most needed. The women physicians present felt betrayed. Dean Marshall responded with the angry retort that she had “been dean of the College since 1886” and she had “yet to see one woman who could be called disappointed.” There ensued a public brouhaha in the form of censure and recriminations that took months to die down in the newspapers and journals.87
Ironically, women physicians were saying much the same thing as Richard Cabot in their public pronouncements. Nor did they cease to make similar statements after Cabot made them listen to their own words. In 1924 Lilian Welsh observed in an article entitled “The Significance of Medicine as a Profession for Women:” “The importance of preventive medicine equals or overshadows in the public mind that of curative medicine and wherever preventive medicine is studied or applied there is a call for women with medical training.... It is fair to predict that eventually all ... State and municipal [health] departments will be administered by women doctors of medicine.”88
Thousands of miles away in India, Dr. Anna M. Fullerton, an 1882 graduate of the college who served for many years on its obstetrical faculty and then became a medical missionary, viewed the Cabot affair with the honest impartiality possible perhaps only for one so removed from the fray. Her diary of 8 July 1915 speaks of having received from her brother a newspaper clipping describing the Commencement Day events in detail. After recording long summaries of Cabot’s remarks and Dean Clara Marshall’s heated response she mused:
I see something of truth in the statements of both these doctors. Dr. Clara Marshall’s facts are correct. Women have made a success of their professional work as physicians and surgeons, and have shown neither lack of intellectual ability nor strength of purpose in the way in which they have carried on their work. It is true, too, that they have carried on this work with greater sacrifice of personal happiness than men are called upon to make, and under greater strain.
One source of unhappiness has, in many cases, been the fact that—being a woman—she has had to face the fact that many people still feel that skilled medical advice must be masculine, and she is subjected to the mortification of seeing her own advice often set aside for that of some man physician whom she knows to be her inferior professionally.
Another thing that makes it difficult for her is the fact that if she would excel in her profession she must live a lonely life, and carry a double burden—her professional, and her household cares also in most cases. Whereas the man may have a help-mate to share his joys and his sorrows and to make his home a harbor of rest after toil, the woman must do without this close companionship. Love of the personal kind, that men account none of the strongest motives for putting forth their powers in the service of mankind—must be denied her. A woman cannot undertake the duties of wife and mother, and at the same time give herself as she should to the demands of a life so strenuous both mentally and physically as that of the physician and surgeon. On the other hand, for many women who must of necessity be shut off from the occupations of home-making for their own husbands and children, the opportunities offered by medical practise for the service of their fellow-men are most satisfying, giving as they do occupation to the mind and heart which are the best compensations for what they have missed in the way of home-making.
Thirdly, because of her mother-instinct, and her faculty for looking into details, a woman doctor carries her patient on her heart as well as in her head, considering the patient more as a child in the helpless condition of disease, requiring close and constant vigilance as to nursing, food and surroundings.
Since God made mothers—and there must, necessarily—be so much of mothering in the care of the sick, one cannot but think that in the larger type of womanhood which advancing civilization has made possible, God means women both to “mother” and “doctor” the race into a healthier and happier state than that in which it now exists.89
As Fullerton well knew, the woman doctor combined professional values—scientific objectivity, rationalism, personal achievement—with female ideals—the nurturing of children, social concern, selflessness, purity. The triumph of a progressive ideology and the ascendancy of social medicine in the first few decades of the twentieth century allowed women physicians to participate fully in an important segment of professional activity while maintaining their identity as women. Bringing their expertise to bear on the more private concerns of the family, women physicians, like other women professionals, became an important component of the “search for order.” The participation of women professionals in the modernization process has generally been left out of the historical record, but it is no accident that the rise of what are now termed the “helping professions” coincided in time with the beginnings of women’s professional activity. Women professionals helped create the liberal welfare state. The ideology of domesticity would, for a time, continue to define their work in the public sphere. Like the health reformers of the nineteenth century who wanted to “make women modern,” rank-and-file female professionals in these specialties helped impose social control and middle-class values on a vastly complex and chaotic society. Whether the historian views this activity as benevolent or repressive does not detract from the fact that women physicians’ participation in the process must now be made a matter of established fact.
Furthermore, the story of women physicians is connected to the story of how twentieth-century American society solved the debate over woman’s nature, searching for and ultimately finding public roles for middle-class women within the professions which would not do violence to woman’s primary and central connection to the family. Late nineteenth-century economic and social developments demanded a drastic expansion of welfare institutions to deal with problems of urbanization and change. The reordering of the professions was a product of the very same developments. Integrally connected to the process was the evolution of nursing, teaching, librarianship, social work, and public-health medicine. The connection is not accidental. In the future, historical accounts of professionalization must better describe the ways that women participated in the process. Women historians who have written about discrimination and defeminization after 1900 are certainly correct. There were concerted efforts to keep women out of some professions altogether and bar them from those intraprofessional specialties that were defined as “male.” Yet other careers were simultaneously feminized, as the middle class explored new boundaries for “women’s work” in a restructured, “rationalized” society.90
In the 1920s women physicians remained strongly identified with public health at a time when the glitter of a public health career began to fade. A changing political climate after World War I routed progressivism; the decline in public enthusiasm for social reform naturally downgraded women physicians’ vision, skills, and perceptions. Finally, the defeat of the Sheppard-Towner Act in 1929 put the finishing touches on the medical profession’s decade-long retreat from social activism.
At the same time, the public witnessed the rise of a new hero, the medical scientist, symbolized and celebrated in the central character of Sinclair Lewis’s novel Arrowsmith. Martin Arrowsmith’s career, as Charles Rosenberg has suggested, recapitulates in narrative form the development of modern medicine in the United States, each stage corresponding to a particular phase in its evolution. In the novel, Arrowsmith moves from his adolescent admiration for the old type of general practitioner, through encounters with various medical personalities—the dedicated clinician, the money-hungry purveyor of technology, the efficient surgeon who has traded his humanity for technical expertise. But Lewis’s most biting sarcasm is reserved for Dr. Almus Pickerbaugh, the exuberant but none-too-bright public-health commissioner of the mythical midwestern town of Nautilus. Amid his own growing cynicism, Arrowsmith discovers that public-health programs were primarily matters of boosterism, politics, and propaganda, providing no role for the serious, medically trained scientist. As health commissioner, Pickerbaugh preferred writing health jingles to studying the epidemiology of disease, and under his inspiration Nautilus became “one of the first communities in the country to develop the Weeks habit.... “ ‘Better Babies Week,’ was followed in succession by ‘Banish the Booze Week,’ ‘Tougher Teeth Week,’ ‘Stop the Spitter Week,’ ‘Swat the Fly Week,’ and ‘Clean up Week.’” The caricature is painfully funny; even down to Dr. Pickerbaugh’s silly jingles, which like the one below, written for “Clean Up Week,” have a particularly insipid ring:
Germs come by stealth
And ruin health,
So listen, pard,
Just drop a card
To some man who’ll clean up your yard
And that will hit the old germs hard.91
At the end of the novel Martin Arrowsmith deserts clinical medicine entirely to become the pupil of his old mentor Max Gottlieb, the pure scientist, and one of the few real seekers after truth in the book. Arrowsmith, too, becomes a heroic scientist, full of integrity but inevitably alone, doomed to withdraw even from wife and child in order to pursue his vision.92 For Sinclair Lewis the new medical hero was a loner, a pure researcher who removed himself from the slough of human existence, and, one hardly needs to add, he was unmistakably a man. Thus, in the very same year that women physicians from Kansas could brag to the annual meeting of the Medical Women’s National Association about an exemplary public-health campaign they had dubbed “Fitter Families for Future Firesides,” Sinclair Lewis was holding up the Almus Pickerbaughs of the world to public ridicule.93
The passing of progressivism deprived women physicians of a particular kind of social validation. One might well argue that women professionals do best in periods of active social reform when women’s concerns gain a more public voice. In the 1920s, a new generation of women physicians came to maturity without having had first-hand contact with a central tenet of early feminism—its commitment to an ideal of feminine purpose. Dr. Sarah Tower, a student of Florence Sabin’s at Johns Hopkins and later a research scientist, remembered her own experience studying medicine in that decade:
The days of pioneering in education for women were over. This decade, the 20’s, with the first World War well behind and the depression still ahead, probably represented the least complicated period,—the period of the simplest attitudes towards education for women, especially medical education, we have yet known. We knew that when we graduated some internships would not open to us, but enough were. By and large we weren’t fighting, we were simply getting educated. At the same time, the days of medical students, women or men, marrying and having babies while still in school had not yet arrived. There was a fair amount of dating between the men and the women, but by and large the main preoccupation of both was getting on with education. Some of the teachers, we knew, took a dim view of women in medicine, pointing to the “wastage” of the training when the women married, and gave up professional careers. But these attitudes troubled us little. We came in fortunate time of consolidation of a good and strong position won for us by our elders, and before the time of facing the new problems and new challenges which were to be created by the winning of that position. The spate of books on “modern women” and “American women” had not yet begun.94
More than ever before, women physicians in the next decades would have to learn to maneuver autonomously in a male world without either a reference group of other women or a coherent public ideology to provide them support. Battles would continue to be fought, won, and lost, but they would be viewed as private battles, irrelevant to the female community at large, with the cost measured primarily in personal terms.