A month later the editor of the Journal of the American Association of University Women chose to make the Times article the subject of her own editorial. She doubted whether women physicians were losing their interest in social medicine as the Times had implied. If there was a falling off of their involvement in public health, the problem was not a change of attitude, “but the grim necessity of earning a living.” Medical training had become “extraordinarily long and expensive.” “Family and social influences playing upon young women,.” even those brought up in families with sufficient economic resources, were not conducive to encouraging a daughter to choose a medical career. Furthermore, women physicians still encountered discrimination, even in the field of public health. “It may be doubted,” the editor concluded, “whether the experience of the few women who have trained themselves for positions of the very highest type ... has been such as to encourage their sisters to follow in their footsteps.” The AAUW Journal confessed “to a less roseate view of the situation so far as the opportunity open to women is concerned,” and wondered about “the exact character of the responsible administrative positions’ ” held by the 250 women mentioned by the Times. ²

The editor of the AAUW Journal did not have statistics at her fingertips, but she was more prescient than she could possibly have known at the time. By the end of the 1920s the position of women in public-health medicine had begun to reflect the precariousness of their position in medicine in general. Though the situation did not become readily apparent until the 1930s and 1940s, two events presaged women physicians’ future marginality, even in their “own” fields of public health and preventive medicine. The first concerns the recruitment of Dr. Josephine Baker to teach at New York University Medical School in 1915, the second, the appointment in 1920 of Dr. Alice Hamilton to the faculty of Harvard.

In 1915 Dr. William Park, both dean of the New York University Medical School and laboratory director for the New York Department of Health, invited Baker to lecture on child hygiene for a recently developed course leading to the new degree of Doctor of Public Health. Realizing that she did not have an actual degree in the field of public health and would soon be hiring male Doctors of Public Health in her own Department of Child Hygiene, Baker offered to teach in return for the right to earn the diploma herself. Park demurred, arguing that the medical school did not admit women. Baker responded by refusing the appointment, later commenting, “I can hardly be accused of acting unreasonably because I declined to act as teacher in an institution that considered me unfit for instruction.” For a year Park searched for an instructor he felt could equal Baker. In the end, the school conceded defeat, admitting Baker to its public health course and opening it to other women as well, all in order to gain her services on the faculty. Although Baker taught at NYU for fifteen years thereafter, every lecture she gave was greeted by hostile clapping from the male students because she was a woman.³

Five years later, Harvard Medical School, wishing to legitimize the field of public health by offering courses in industrial medicine, ended a vigorous search for an appropriate faculty appointee by settling reluctantly on Alice Hamilton, a pioneer in industrial toxocology. Harvard had never appointed a woman to its faculty, and would not appoint another for decades to come, but even the most ardent opponents of women in medicine had to admit that Hamilton was the best in her field. When Dean David Edsall approached her, however, he offered Hamilton only an assistant professorship, making clear that she could not march in the commencement along with other professors, would be barred from the Harvard Club, and must never expect to claim her quota of football tickets.⁴

Thus, though women doctors and other contemporary analysts viewed the period between 1910 and 1930 as one of increased opportunity and expansion, history suggests that the suspicions of the editor of the Journal of the American Association of University Women were closer to the mark. In spite of a spate of magazine articles that appeared to legitimate, even glorify, the ambitious career woman who began to work outside the home, and in spite of the falling away of most formal barriers against women in medicine (by 1930 all but six medical schools were coeducational) women doctors made even fewer gains than women in other professions. At a time when the number of female law students doubled from 1920 and 1930, and the number of women who received Ph.D.’s tripled, enrollments for women at medical schools rose at a snail’s pace. While male students increased their numbers by 59 percent, the female growth rate was 16.7 percent. Moreover, the 1920s set the pattern for the next forty years. Except for sharp but temporary upsurges in female medical school enrollments at the end of World War II, the numbers of women in medical schools fluctuated between 4 and 5 percent until the beginning of the 1960s.⁵

By the middle of the 1930s, women doctors themselves were beginning to concede that the promise of the early decades of the twentieth century had been elusive. In June 1936 the AMWA Committee on Medical Opportunities for Women reported that female physicians had lost ground even among Departments of Child Hygiene, where they had originally been so numerous. When Sheppard-Towner was first inaugurated in 1921, forty-five states created positions of chief of Child Hygiene, and only three of those appointments were given to men. Little more than a decade later, all forty-eight states were operating such departments under the provisions of the Social Security Act, but only seventeen women, compared to thirty-one men, were state chiefs. Even more disappointing, the position of chief of the Division of Maternity and Infancy of the Children’s Bureau, traditionally a woman’s job, was also now held by a man. Just as the original AMA Woman’s Committee on Public Health had gradually given way to the Council on Health and Public Instruction in 1913 with no women members, so the field of social therapeutics, where women physicians had been so visible, was absorbed into the institutional mainstream of American medicine with a resulting limitation on women’s participation.⁶ Women would continue to find low-paying, low-status and part-time public-health work, but public-health administration would pass into the hands of male physicians, trained in the new public-health schools connected to prestigious medical schools.

In 1939 a saddened Josephine Baker surveyed the results. “Not long ago,” she wrote,

What, exactly, was going wrong? For one thing, women doctors misperceived the extent to which social attitudes had changed in their favor. And who could really blame them? No one would deny that the formal barriers to their entrance into the profession had been unequivocably diminished. Only a handful of medical schools still refused to open their doors to women by the 1920s. Older women who could still recall a dramatically different climate marveled at the contrasts. “When I was starting the study of medicine,” wrote Rosalie Slaughter Morton, a graduate of the Woman’s Medical College of Pennsylvania in 1897, “I was going into what had been considered by the ruling forces ... a man’s profession,.... And then came what seems a miracle. The world speeded up its revolutions, bringing changes overnight.... We women who are now fifty are the first generation which has felt the click of progress in the making.” Similarly, Josephine Baker recognized that women physicians were no longer viewed by the public as oddities. “When I think back to those years so long ago,” she wrote in 1939, “it is difficult to keep proper sequence in mind. The idea of women in the medical profession is so familiar and commonplace to me now, and it was so strange and unconventional then.”⁸

Younger women who had attended coeducational medical schools were even more likely to believe that much had changed. “The age is past when one expects to find in coeducation schools the difficulties the pioneers ... had to contend with,” Alice Weld Tallant, professor of obstetrics at the Woman’s Medical College of Pennsylvania and a graduate of Johns Hopkins, told her colleagues in 1917. “From my experience it is perfectly fair to say the opportunity is absolutely equal for men and women throughout.”⁹ “The woman who works hard and is seriously interested in becoming a very good doctor is as much recognized as any one,” agreed Connie Guion, a graduate of Cornell, and the newly appointed chief of Cornell Clinic in 1929. Even Florence Sherbon, active in the American Medical Women’s Association and deeply concerned in 1925 about her “definite impression that the ratio of women to men in medicine is not increasing,” was shocked to hear from a group of female college students that they dreaded male prejudice. Though not their only concern, this fear still contributed substantially to their decisions to steer clear of a career in medicine. “I had the good fortune,” she told them, “to attend a medical school where women always had been received on an equal footing with men.... There were no traditions of anything else.... I hate to give up my conviction that essential sex prejudice is rapidly becoming a thing of the past.”¹⁰

Indeed, successful women physicians clung so doggedly to the belief that in general the profession now welcomed women that sometimes they tended to blame the victim by voicing their disappointment in younger women’s career choices and lecturing college students about their frivolity. Florence Sabin, for example, commented testily in 1924 to an eager first-year Hopkins student that “the females in the Johns Hopkins Medical School used to be serious-minded women, but now they are just nice girls.” Similarly, Anna Voorhis, president of the Women’s Medical Society of New York State, worried that men took “their profession more seriously than do women,” and Rachelle Yarros urged women physicians to stop complaining “any more that we are not getting opportunities, but let us recognize the fact that we are not making opportunities.” Florence Sherbon, concerned to discover the reasons for a lack of interest in medicine among female college students, suggested that they were perhaps mistaking for sex prejudice the replacement of “chivalry and sex privilege” with “equality and justice.” “We do have to learn to be ‘good sports but perfect ladies’ in the necessarily vigorous give and take of professional association and competition,” she urged tactfully. “We have to divest ourselves of the age-old idea that the perfect gentleman should give a woman a handicap start because she is a woman.”¹¹

It was not that women physicians were necessarily naive about the continued existence of institutional discrimination. Bertha Van Hoosen, who headed the AMWA Committee on Medical Opportunities for Women throughout the 1920s, periodically published even-handed and detailed reports concerning the status of women in medical schools, internships, and residency programs. She was never reluctant to expose bias when and where she found it: in the refusal of many AMA-approved hospitals to,open up their internships and residencies to women, in the excruciatingly low number of female medical faculty throughout the country, in the fact that “many schools limit the number of women regardless of the number of applicants,” in the surgical tracking systems which insured that the majority of women surgeons would be those trained at a woman’s school, and even in the leadership of the profession, where through the year 1927, only one woman physician had held national office in the AMA.¹²

Other women physicians besides Van Hoosen were equally outspoken in their conviction that the profession was dominated by men who refused to grant women equal status. “Men do not want women in their institutions and organizations except as subordinates and auxiliaries,” wrote Inez Philbrick in the Medical Woman’s Journal in 1929. “As assistants, technicians, nurses, and stenographers, they are greatly appreciated and most indispensible. As competitors for equal recognition men simply tolerate us under compulsions.”¹³ Thus, medical women knew quite well that there were still significant vestiges of public and professional opposition. But the important battles had been won. The remaining task was straightforward: to investigate and expose the persisting forms of institutional discrimination. Apparently far more difficult for them to tackle was a much more insidious problem: the fact that a public debate over the “working woman” which took place in the 1920s was being resolved in a manner that would continue to make it hard for a woman to commit herself equally to career and family.

Though the achievement of female suffrage may have brought an end to a particular brand of public feminism, and the appearance of the flamboyant, devil-may-care flapper may have misled many analysts into the observation that feminism in the 1920s had lost its constituency, historians now know that what really occurred in this decade was that feminism changed its focus and direction. Barnard Professor of Economics Emilie Hutchinson correctly characterized the shift when she observed that the center of concern had moved from education and suffrage to the more basic problem of economic opportunity. And, indeed, Americans in the years after World War I began to wrestle with the question of the future position of the homemaker in American society. The most fundamental issue was whether or not to grant public acceptance and approval to the gainfully employed married woman.¹⁴

From 1890 to 1920 the proportion of married women workers rose from 3.3 to 7.3 percent, an increase of from 12 to a little over 21 percent of all women workers. In the 1920s working wives continued to participate in the labor force, and by 1930 they comprised 28 percent of all female workers. By the middle of the decade feminist concerns began to reflect these significant changes when a group of self-styled “New” feminists—primarily educated women professionals, some of whom had little emotional attachment to the nineteenth-century suffrage campaign—focused their public concerns on the conflicts middle-class women were experiencing when trying to balance marriage, family, and work. These new feminists rejected the notion of nineteenth-century social feminists that women could rightfully function in the public sphere only if their work made a significant contribution to the good of the community and claimed for themselves the personal and individual self-fulfillment that allegedly accrued to people who enjoyed satisfying work lives. In addition, they insisted that women need no longer be forced to choose between marriage and a career. The modern woman, wrote the journalist Dorothy Dunbar Bromley in an outspoken article in 1927 which became a kind of manifesto, was tired of “old school ... fighting feminists who wore flat heels and had very little feminine charm.” Such women were “zealous” and their methods “inartistic.” The present generation of feminist—“ new style”—believed “that a full life calls for marriage and children as well as a career.” Like many older feminists, she valued her “economic independence... above all else,” but was also “hard put to it to understand the sex antagonism which actuates certain advanced women.” Excited at the prospect of combining work with a career, the new feminist, according to Bromley, hadn’t the time to concern herself with silly details like whether or not she should keep her maiden name. Her purpose was to “emerge from a creature of instinct into a full-fledged individual who is capable of molding her own life.” Thus, she would freely admit that “home and children may be necessary to her complete happiness,” but she would no longer let men and children totally “circumscribe her world.”¹⁵

Feminists like Bromley believed that they had the new psychology and Freudianism on their side when they cited a genre of 1920s literature that linked the modern woman’s social isolation in the home with neurotic housewives and poorly socialized children. Picking up the argument of earlier theorists Charlotte Perkins Gilman and Olive Shreiner, new style feminists, too, stressed the connection between economic independence and individual self-esteem in more “modern” terms. Educator Ethel Puffer Howes worried that training women and then underutilizing their real abilities augured physical and emotional disequilibrium. “Probably no man who has not experienced it,” wrote the advice columnist of Woman’s Home Companion, “can conceive the ravages of financial dependence on character, the having nothing in the world he could call his own, except as a gift from someone else.” Both the psychologist Lorine Pruette and the radical feminist Suzanne La Follette, anticipated the concerns of feminists in the 1960s when they argued that uninterrupted domesticity was leading to mental deterioration. In Concerning Women La Follette accused consumerism, technology, and advertising of hypnotizing American women so that the majority of them lived “without the exercise of the reflective intellect, without ideas, without ideals, and in a proper use of the word without emotions.” Pruette worried that the monotony of domestic labor sapped energy and self-esteem, and prescribed part-time work as an antidote.¹⁶

“Modern” feminists militantly rejected the single life in favor of companionate marriage. Though increasingly from 1900 on small numbers of middle-class women had attempted to combine children, careers, and a marital relationship of shared intimacy and mutual support, new feminists correctly accused their forbears of viewing family life and public life as mutually exclusive. By the 1920s experiments in fusing work and family life were talked about publicly. Career feminists viewed themselves as a new kind of pioneer, insisting that their choices were a break from the past. They rejected what they termed the “self-assertive and antagonistic feminism of the past,” where women “worked against heavy odds and usually had to buy success at the price of marriage and children, sometimes charm and personal appearance, of being considered queer—as some of them undoubtedly were,” with nary a glance behind them.¹⁷

Arrogant, perhaps, in their unwillingness to acknowledge the struggles of older women who shared their goals and desires, career women in the 1920s had in fact experienced some important cultural changes. Unlike their mothers, who had lived in an age more tolerant of female bonding and the intimate friendships between women that often spanned an entire lifetime, the women of the new generation grew up in a cultural climate that vehemently stressed eterosexuality and downplayed female relationships. These attitudes reflected a radical redefinition of female sexual nature. The new feminist could be a man’s pal as well as his willing and eager sexual partner. She felt little compulsion to defend or extol female capabilities in the abstract, admitting that American women had “so far achieved but little in the arts, sciences and professions as compared with men.” Gone was the assumption of female superiority and natural guardianship, the sense of sisterhood. The new feminist, indeed, preferred to work with men because their methods were allegedly “more direct,” “their view larger,” and she could deal with them on the basis of real companionship. “Woman usually prefers to work with man, of a truth,” admitted Dr. Luella Astell, president of the Wisconsin Medical Women’s Society, “but that is no one’s fault. If it were not so, the marriage institution would become obsolete. To admit such a preference is simply to declare oneself a normal woman with healthy sex instincts. It’s nothing to be ashamed of.”¹⁸

Indeed, only paid employment for women could presumably alter the power relationships within marriage and make it truly a union of equals. Satisfying work, with intellectual stimulation and healthy contact with the outside world, would give women the same opportunities for self-development that their husbands enjoyed. The result would be female competence and creativity in both spheres, with a particularly beneficial influence on the home. “May it not be possible,” mused the economist Chase Going Woodhouse, with a nod in the direction of Elizabeth Blackwell,

For a time the advocates of career and marriage looked on expectantly as magazines and journals of all sorts took up the cause of the new breed of woman. Articles on “fifty-fifty” marriages and “the home-plus-job-woman” dotted the pages of the Woman Citizen, the Atlantic Monthly, Woman’s Home Companion, the New Republic, and even the Ladies Home Journal, which only a few years earlier had opposed women’s suffrage. Statistics suggest that growing numbers of young women were not quitting their jobs after marriage, but were extending their period of employment at least until the birth of their first child. For example, the number of married professional women rose from 12 percent in 1910 to 27 percent in 1930. Yet perhaps as a response to the literature on working wives, the 1920s were also a decade that renewed its interest in the mother-child relationship. John B. Watson’s manual Psychological Care of Infant and Child, published in 1928, held for this generation the same fascination that Benjamin Spock’s Baby and Child Care would for the next. Watson’s emphasis on rigid schedules and the rational control of affection between mother and child still assumed that the mother’s role was “second to none.” “The having of children,” he wrote, “is almost an unsuperable barrier to a career.” ²⁰

Spotlighting women’s central role in child rearing exposed the Achilles heel of the new feminism. Not only did the work of psychologists like Watson reinforce the ideas of those who were threatened by the desire of new feminists to restructure family life, but it also split the ranks of those eager to facilitate matters for working wives. A number who advocated combining marriage with gainful employment were careful to distinguish between working wives and working mothers. Many new-style feminists believed that working wives should become full-time mothers once their children were born. “At the present time,” admitted Henrietta Rodman, a leader of the radical Greenwich Village Feminist Alliance, “the care of the baby is the weak point in feminism. The care of children, particularly those under four or five years of age, is the point at which feminism is most open to attack.”²¹

Despite the best efforts of feminists in the 1920s, the problem of balancing motherhood and careers remained unsolved. Mary Ross reasoned that women had but one choice, to subordinate their careers to those of their husbands or to pursue work only at intervals guided by childbearing. The journalist Eva Hansl of Harper’s Monthly Magazine, wrote that “ ‘Being there’ is the greatest contribution we mothers can make in the lives of our children.” Some feminists found private solutions by marrying but not having children. Of the seventeen women who were invited by Freda Kirchwey in 1927 to explore the personal sources of their feminism on the pages of the Nation—“to discover the origin of their modern . point of view toward men, marriage, children, and jobs”—only five were mothers. Most of the childless women in the group worked only part time, carefully choosing jobs which gave them the flexibility needed to run a household. Others hired full-time nurses and housekeepers. Similarly, a study of professional women by Virginia MacMakin Collier in 1926, revealed that the overwhelming majority left their children in the care of servants.²² Women physicians, of course, for whom professional success did not afford the luxury of moving in and out of active participation at will, were practically forced into such a solution.

Also painful and confusing to the growing number of women seeking to combine marriage and work was the feeling that their efforts attracted neither the admiration nor the interest of most of the young women who came of age in the 1920s and who chose marriage over work. From 1900 on, in fact, fewer and fewer women were deciding to remain single. College-educated women, unlike their predecessors, who had rejected marriage so emphatically at the end of the nineteenth century, were increasingly recording their preferences for marriage over a career. Whereas estimates have found that roughly 25 percent of the women in 1900 who had received bachelor’s degrees remained unmarried, and 75 percent of the women who earned Ph.D.’s between 1877 and 1924 were spinsters, polls taken in the 1920s reflected the heightening popularity of marriage for all women. Educated young women’s reported preference for marriage over jobs seemed particularly troubling to feminist observers. In 1927 Lorine Pruette admitted that most of these young women were “frankly amazed at all the feminist bother and likely to be bored when the subject comes up.” Her own research on middle-class teenage girls revealed that of the third who would have considered giving up marriage for a career only a small proportion of them understood the implications of such a choice. The others talked about careers in Hollywood or fantasized unrealistically about glamorous jobs. Polls taken at various colleges revealed similar trends. A canvass of Vassar women in 1923 found that 90 percent wanted marriage, “the biggest of all careers.” Seven years later 70 percent of the graduates of New Jersey’s College for Women rated husbands and families as their top priority. ²³

The good-natured willingness of college women to steer clear of career commitments that appeared to threaten future home and family life confounded women physicians, just as it did other female professionals. But they hardly knew how to solve the dilemma. For the most part, they contented themselves with identifying and publicizing the problem. Florence Sherbon’s article in 1925 enjoined the readers of the Medical Women’s Journal “to begin vigorously to think our way through this question.” Believing that the present age was witnessing “a reaction from female celibacy” as a “refreshing number of young college women declare with conviction that they want to have children,” Sherbon urged her female medical colleagues to look to themselves for role models. “How many medical women marry? How many have children, and how many children? How do those that do marry and have children manage to make a home and do their duty by husband and children?”²⁴

Some female medical educators only hesitantly endorsed marriage and medicine. Dean Martha Tracy of the Woman’s Medical College of Pennsylvania announced in 1932 that marriage, medicine, and motherhood could be combined, but she emphasized that self-control, poise, and maturity were needed in order to achieve success. She confessed a strong aversion to young women who had already married in medical school and felt family life should be postponed until a woman completed her medical studies and her internships. “The matter of young married internes is a serious one,” she cautioned. “I’ve known many who expect to thoroughly disorganize hospital regime and secure for themselves unusual privileges in order to be with the newly acquired husband.” As a member of the Board of Internes for the College Hospital, she confessed a hesitation to appoint young married couples. “You see sentiment and sentimentality may overcome science, if only temporarily,” she explained, “but during that period it is a dangerous element for disorganization.”²⁵

Tracy’s ambivalent attitudes reflected how women physicians struggled with the issue. Individual women continued to worry about the “matrimonial mania that possesses both young men and young women” and believed that it had a great deal to do with the difficulty of recruiting good women students. Others were more accepting. Adelaide M. Brown, herself the daughter of a pioneer woman physician and for a long time connected with the San Francisco Children’s Hospital which her mother helped found, was more optimistic. “Marriage comes into open competition in many women’s lives,” she admitted. “The woman physician seldom realizes the double tug on her brain and her emotions which this double demand will make.” But Brown, much less cautionary than Martha Tracy, encouraged medical marriages nevertheless. She did admit, however, that the married women doctors who had the most successful careers were those who chose medical fields with “less responsibility,” namely, clinical and laboratory positions, work in pathology or part-time social service, psychiatry, and salaried hospital jobs.²⁶

Even the Woman’s Medical College of Pennsylvania offered no easy solutions to this central dilemma of women’s lives. Marion Fay, later dean of the college but in the 1930s and early 1940s the head of the Department of Physiological Chemistry, remembers that she was considered “a disgrace by some of the women faculty members” because of her approval of women’s combining marriage and medicine. “Some of the older M.D.’s on the faculty,” she recalled, “thought I was simply outrageous, that I was promoting matrimony. I can remember one dear soul who just announced to all and sundry that no woman could possibly be a doctor and be married.... I was accused of being a marriage counselor.” When a married student came to Fay in tears with the news that she was pregnant, expecting to be chastised and thrown out, Fay’s response, “Oh, isn’t that wonderful!” nearly knocked the poor girl from her chair. But in the end, the college did not dismiss the young woman, as a coeducational school might have, and after some difficulty arranging things she graduated with the rest of her class.²⁷

Thus, solutions were private and piecemeal. Of the twelve women physicians who attended medical school in the 1920s and 1930s interviewed for the Medical College of Pennsylvania’s Women in Medicine Oral History Project, the single women all had full-time careers. Of those who married, only two, Irene Koeneke and Katherine Sturgis, continued steady medical work after receiving their degrees. Koeneke married a man twenty-seven years her senior who was a major figure in the medical profession in Kansas, and she remained childless. Sturgis attended medical school after her children were of school age, but even then was forced by circumstances to have them live for many years with her ex-husband and his new wife. What is more, Sturgis had originally wanted to attend medical school after college, but was diverted from her goal when she fell in love with a young engineer and eloped with him at the end of her freshman year. She resumed premedical studies only after her divorce. Although none of the other women gave up medicine entirely, all of them worked at medical “odd jobs” while their children were young. Natalie Shainess, whose career in psychiatry gathered momentum after her children were grown, maintained a limited private practice. Caroline Bedell Thomas began to make her most important contributions to epidemiological research only when she was in her late fifties and sixties, and worked at a series of fellowships and part-time clinical appointments when raising her three children. Finally, Louise de Schweinitz practiced no medicine at all for the first three years after her children were born. Returning to medical work part-time, she held a variety of positions, including clinician at a pioneering birth control clinic; nursing instructor; physician to a school district, a summer camp, and a university student health service; health lecturer; and attendant in a number of well-baby clinics. Significantly, all of the women married fellow physicians. The contrasts in the professional lives of the married and unmarried women suggest that Florence Sherbon’s warning, “We have got to settle all this before a large number of serious and brainy young women are going to matriculate in medical schools,” hung over medical women like a pall.²⁸

Lack of adequate solutions meant that large numbers of women, even those whose aspirations had been for a full and intense professional life, would falter in the attempt to balance career and family. When such women “failed,” they tended to blame themselves. Louise de Schweinitz, for example, felt that her inactivity in medicine after the birth of her five children occurred because “there was something lacking in me.” Though she never discussed the problems of staying professionally active with her husband, she believed years later that he “was sorry I hadn’t done more in medicine at the end of my career.”²⁹

By the end of the 1920s, confessions of failure from many working women began to appear in a number of magazines. Articles by “ex-feminists” told sad, funny, and often self-deprecating stories of the slow death of their idealistic goals in the face of familial demands. One such “confessional” entitled “Men are Queer That Way; Extracts From the Diary of An Apostate Woman Physician” was published in Scribner’s Magazine in 1933 by a graduate of Johns Hopkins, Dr. Mabel Ulrich. The diary began with an excited and hopeful entry in the last year of medical school:

Only months after the marriage, however, the experiment faltered. “It is no go,” Ulrich wrote. “We have given up the 50-50 housekeeping plan. We tried for a month, but by the end of one week I knew S. is a fearful mess as a housekeeper.... Could never remember the laundry.... But then of course he is busy and I am not.”

For the next seven years Mabel Ulrich struggled to balance private practice, family, and children. But even with servants the job proved a difficult one:

Minor “incidents” abounded. After a visit from an unmarried female medical classmate, now a physician, Ulrich noted the contrast between her friend’s “stunning” professional good looks and gay self-confidence and her own disorganization, vowing that “somehow I have got to get some new clothes.” She gradually realized that her husband’s affections for her were aroused, not when she was brilliantly diagnosing patients, but when she was “in the kitchen with an apron on, or sewing on a button.” Forgiving him, she mused,

For a time Ulrich, discouraged in the slow development of her own practice, tried her hand at being her husband’s lab technician to save money. The plan was thwarted when she discovered that he didn’t trust her work and felt the need constantly to corroborate her findings. 7 August 1911, begins with the entry, “Have walked out on my job,” and ends with the observation, “Verily I am no technician. But oh what a woman I should be if an able young man would consecrate his life to me as secretaries and technicians do to their men employers. Yet I can’t rid myself of a sense of guilt and failure. My Victorian hangover at work.” After turning down the offer of organizing and heading up a health service at a major university because she felt it would be too difficult for her husband to move his practice to another city, Ulrich admitted, “I don’t believe a woman’s work is ever so important to her as a man’s is to him. ”

Mabel Ulrich ultimately gave up her private practice and found her niche as a lecturer in social hygiene and preventive medicine. During the years before World War I and into the 1920s she did service in antivenereal disease campaigns alongside numerous other women physicians who found health education a career choice more compatible with family life. During the Depression Ulrich became the Minnesota state director of the Federal Theater Project.³¹

Uncertain of the long-term effects on themselves, middle-class women who worked were even more doubtful concerning how their choices would touch the lives of husbands and children. Wrote one mother:

Thus, for all the hopeful veneer of a professional social climate which had discarded the most blatant formal barriers against women’s entrance into the medical profession, the necessary changes in family life and in child-rearing practices that would have allowed the ordinarily competent but not superior woman to consider a medical career did not materialize in the 1920s, or, for that matter, for half a century thereafter. Women who wished to solve the dilemma were generally left to themselves to devise individual solutions. No wonder they remained unsure of themselves when they made the attempt.

By the end of the 1920s, the factionalization of the woman’s movement after 1925, the subsequent disappointment of many that women’s suffrage did not bring the hoped for “gender gap” on political issues, and the increasing ineffectiveness of the reform coalition in the face of conservative political reaction meant that there would be no coherent, centralized feminist coalition to help interpret the problems encountered by women “trying to be modern.” Most troubling of all, the continued absence of effective solutions to the private and personal dilemmas of those young women who wished to combine marriage with gainful employment outside the home obscured the fact that the problems they encountered in fulfilling those intentions resulted not from some personal inadequacy, but from a fundamentally inegalitarian social structure which persevered despite the enormously compelling but ultimately cosmetic changes which the 1920s had wrought.

Medical practice, then, exhibited none of the characteristics that began to be associated with women’s work by the end of the 1920s. It demanded an investment in time and educational training that far exceeded the typical white collar, clerical, service, and sales occupations growing more popular with middle-class women. Even positions as managers and proprietors and jobs in the feminized. professions of nursing and social work required shorter training and provided more flexible work schedules.³³ Finally, continuous structural and professional changes within the organization of medicine itself also helped keep down the numbers of women in medicine.

Efforts to reform medical education and raise the entry requirements to medical school continued throughout the 1920s. By 1930 only seventy-six medical schools remained in existence, all of them with A ratings, compared to 166 in 1904. In another development, schools began to increase the number of college credits required for admission. In 1930 some 70 percent of medical students had baccalaureate degrees, while twenty years earlier only 15.3 percent had completed college. Then, in 1921, Johns Hopkins Medical School decided to limit the size of its freshman class rather than to admit all qualified applicants. By 1924 fifty-four schools had followed suit. Such a policy made acceptance much more competitive and gave school officials more control over admission policy. Equally significant was the growth of specialization and the consequent lengthening of medical education first to an internship year and then to several years additional training in approved residency programs.

In the early decades of medical reform, the longer term of study and the higher standards caused a noticeable drop in both male and female enrollments. But as was demonstrated in Chapter 9, female enrollments dropped more precipitously than did men’s. By the 1920s, overall applicant numbers seem to have adjusted to the more stringent requirements and began to increase steadily, but female growth rates were excruciatingly slow. Though up from 3.4 percent to 5.9 percent in 1920, numbers fell back to 5.4 in 1924 and fluctuated thereafter from between 4.5 and 6.5 percent until the 1960s.³⁴

These structural changes in medical education combined with the cultural prejudices against women professionals which we have discussed to work against female medical aspirants in several crucial ways. First, there was the matter of cost, a problem touched on by the editor of the AAUW Journal in her 1921 article. Medicine was the most expensive of the professions to enter. Yet even well-to-do families were only rarely willing to finance a daughter’s medical training. Medicine’s demanding schedule also made it the hardest professional training to combine with part-time work. Finally the unequal job structure meant that women would generally have fewer opportunities for self-support, and, when they could work, their wages would be lower. No wonder the college women Florence Sherbon interviewed in 1925 complained of the high cost of medical education and the difficulties of self-support as a deterrent to a medical career.³⁵

Katherine Sturgis, interviewed in connection with the Women in Medicine Oral History Project, had come from a wealthy family reluctant to support her medical career. She remembered teaching Sunday school, running the school bookshop, and taking on other odd jobs to earn money. Living with her two children during the first years of medical school in Philadelphia, she recalled that sometimes “we were so broke ... we once had the electricity turned off and sometimes we ran out of coal.” Another interviewee, Pauline Stitt, a student at the University of Michigan, babysat, ironed shirts “in interesting faculty homes,” cooked and cleaned, and gave blood in order to save up for medical school.³⁶

Statistics confirm that women found it more difficult than men to put themselves through school. A 1929 government study revealed that in 1927-1928, 45 percent of the male undergraduates to only 25 percent of female coeds earned part of their college expenses, suggesting that most women either received full support from their families or didn’t attend school at all.³⁷

Medical women were aware of these financial constraints. In 1918 Martha Tracy, dean of the Woman’s Medical College of Pennsylvania complained that,

Women also obtained scholarships with greater difficulty than did men. Of the 24,328 educational scholarships available both to women and men in 1927-1928, funds were awarded to only 8,834 women. Seven hundred forty-seven of the scholarships available were exclusively for medical education, and women received only 7 percent of them. Even these were inadequate because they covered tuition only, without any allowance for living expenses. Attempting to remedy the problem, women doctors and other women professionals called for women’s organizations to “make possible the provision of adequate financial assistance to women of outstanding promise in the medical field. This aid is needed at both the undergraduate and post-graduate levels.” Both the Alumnae Association of the WMCP and the AMWA had scholarship funds, but the money was never adequate.³⁹

Competition for places in medical schools heightened as schools took steps to hold down attrition rates and admit only those outstanding students whom they could be certain would finish the medical course. By the end of the 1920s applicants presented credentials that often exceeded most of the schools’ official requirements. While still only two institutions insisted on a baccalaureate, in 1929 45 percent of the applicants had bachelor’s degrees, while 49 percent had at least four years of college credit. After 1925 Johns Hopkins instituted a policy of looking only at the best students from the best schools, and requiring a deposit of $25 and a personal interview with the application. Anticipating that this move would curtail their enrollments for several years, Hopkins officials were amazed to learn that over a hundred outstanding students applied in 1927 for their 75 places. Hopkins’s new policy helped to reduce its attrition rate substantially, and in time other schools adopted its methods. Analyzing these changes in the applications statistics, Dean Burton Meyers of the Indiana University Medical School observed,

At first glance the application statistics do not reveal overt discrimination against women. Indeed, Dean Meyers of Indiana University declared that they even hinted at a slight female bias. In 1929, for example, 65.5 percent of the women applicants were accepted to medical school, while only 51.0 percent of the men were admitted. Overall, roughly half of the applicants of each gender were admitted each year for the next four decades. In the 1970s the number of women admitted exceeded half temporarily for a few years. Not all the medical schools pursued a coordinated policy of institutional discrimination. Quotas, when they existed, were scattered and inconsistent, with some schools having very few or no women students and others, including some of the better institutions like Stanford, Columbia, University of Chicago, and Johns Hopkins, admitting up to 10 percent. However Meyers’s conclusion that women received slightly preferential treatment ignbred the fact that female applicants were even more qualified than their male counterparts—something he himself admitted in his report. “We are probably justified in assuming,” he wrote, “that a higher percentage of women who present themselves for matriculation in medical schools are well prepared for the study of medicine.”⁴¹

Of course such an observation was no surprise to women doctors. Grace Goldsmith, who edged out the future heart surgeon Michael E. Debakey for the top position in her 1932 graduating class at the Tulane University School of Medicine, and who later did important nutrition research and ultimately retired as dean of her alma mater, believed, as did many of her successful female colleagues that “on the whole, women have to work harder and do more, and seldom are equally paid.” Goldsmith was one of six women students in a class of 108. Similarly, Martha Tracy, in her study of female medical graduates published in 1927, reported that most of them agreed “that a woman must be about 50 per cent superior in the quality of her work to receive the same consideration as a medical man.”⁴²

Evidence suggests that once women were accepted to medical school, they performed as well if not better than their male counterparts. Bertha Van Hoosen polled over forty medical colleges and found that women equalled the men as students. But her inquiry also revealed a widespread assumption among administrators that women dropped out of medicine to marry. One of her official respondents judged the attrition rate among women to be as high as 50 percent, concluding that “the education of women medical students [was] about twice as expensive as men.” Indeed, the general disappointment in women’s commitment to medicine was often so pervasive that women physicians themselves voiced doubts. In a letter to Florence Sabin, Adelaide Brown, who in 1923 was considering endowing a fellowship for women in gynecology and obstetrics at one of the California medical schools, worried that women students she had observed were not performing as they should. Disappointed with the career choices of female medical graduates in the last ten years, she had noticed that most wound up in “Anaesthetics & Pediatrics ... Infant Feeding ... or Matrimony.” “I had a talk with Dr. Edsall about Harvard Medical School & the possibility of its being opened to women students,” she informed Sabin. “He told me ... the general opinion ... that women were far less likely to contribute to the world by active work in medicine and ... they felt it was more valuable to train more men as the number was necessarily limited.” In a commencement address to the graduating class at the Woman’s Medical College of Pennsylvania that same year, Sabin herself urged the audience not to give up medicine when they married because it contributed to prejudice against women doctors. “Indeed,” she concluded, “one of the next steps in the feminist movement is for educated married women to claim and to carry on a share of professional work.”⁴³

In 1938 Martha Tracy reported the overall dropout rate for medical students at 25 percent. There is no conclusive evidence to suggest that the attrition rate of women medical students was considerably higher than mens, but it might have been. It is true that the proportion of female students decreased in the 1920s, but one historian has argued that enrollment figures in these early years do not account for women who transferred schools or took leaves of absences. Also absent from the statistics is any adjustment for the variance in program length. However, a study of medical student attendance between 1949 and 1958 does find women dropping out of medical school twice as often as men (15 percent to men’s 9 percent). By this decade the overall dropout rate for all students had declined to a little over 8 percent. Moreover, female medical students’ attrition rate was considerably lower than the dropout rate for women in other professional occupations like law, academia, or engineering. ⁴⁴

Discriminatory assumptions about women’s commitment to the profession continued to make it difficult for them to receive equal treatment. By the end of the 1920s female medical educators had begun to complain that “the increased competition hurt women.” The 1928 AMWA report of the Organization Committee included Mary McKibben Harper’s warning that “covert opposition, of a dangerous variety” was visible in “the increasing difficulty with which women enter medical colleges.” “Study carefully the actual and relative numbers of women students admitted to the university medical schools,” agreed Martha Tracy a year later. “Awake anew to the fact that these schools are not increasing their opportunities to women students and do not intend to do so, for competition for places by men is too great.”⁴⁵

Although women physicians might disagree on the relative equity of their chances for admission to medical school, few of them would dispute the fact that good internship and residency programs were extremely difficult to obtain. In 1922 Alice Hamilton, who kept herself aloof from the American Medical Women’s Association and bitterly opposed the Woman’s Party Equal Rights Amendment platform because of its threat to protective legislation for working women, commiserated on the question of advanced training with Dr. Mary O’Malley, an officer in both the Woman’s party and AMWA.

The difficulty for women was especially poignant because women doctors enthusiastically accepted the rise in standards that lengthened internship and residency requirements appeared to represent, and in their struggle to be as good or better than the men, they hardly realized how higher standards and limited programs would adversely affect them. But worry about internship opportunities surfaced as early as 1901. In August of that year Helen MacMurchey published a study that revealed that there were 203 women holding hospital appointments in the United States. Although the number of women graduates from 1900 to 1922 stayed a little below 200 each year, few of the available internships were the most desirable ones. Complaints continually surfaced that the coeducational medical colleges, by their indifference to helping women obtain hospital appointments, were not following through on their commitment to educated women students.⁴⁷

In 1926 the undefatigable Bertha Van Hoosen surveyed the internship opportunities for women once again. Though she found that a total of 1,047 internships were available for roughly 212 graduates, the figures were misleading because many of the hospitals listed would “not consider a woman intern unless it is impossible to get a desirable man.” Seventeen states had no hospital at all willing to accept a woman, and most of the opportunities were concentrated in Pennsylvania, New York, California, and Illinois. Over and over again hospitals complained of the problems involved in housing women interns, although it was clear from the response of many administrators that this excuse would be set aside if a woman was really needed. Such a situation arose during World War I, when many women doctors were hired to replace men who left for the army. Margaret Castex Sturgis, for example, a graduate of the Woman’s Medical College of Pennsylvania in 1915 and recently married to an army physician working at Fort McPherson who was waiting to be shipped overseas, wrote her old dean, Martha Tracy, in July 1918 that she was looking for a hospital job. After an exchange of several letters she reported excitedly that she would be replacing New York Hospital’s resident physician, who was leaving for the army.⁴⁸

After the war, however, women were not so fortunate. In 1923 Louise de Schweinitz applied to three Boston hospitals for an internship in order to be in the same city as her physician husband. All three of them turned her down because she was a woman. She wound up an intern at the New England Hospital for Women and Children without even bothering to assess the quality of its program simply because it was in Boston. For a graduate of Johns Hopkins, interning at the New England was a step down in the quality of her training. At the time it was not a teaching hospital, and de Schweinitz knew that the training was not on a par with what she had received in Baltimore. But she felt that she had no choice.⁴⁹

Quality residency training was even more difficult to obtain than a good internship. Even at Johns Hopkins, where according to one woman faculty member, “the woman medical student is tolerated during her undergraduate days,” a woman was “given early in her career to understand that she can go only so far in the department and no further.” Recalling the experience of one young woman graduate when she applied for an internship there, Professor of Psychiatry Esther Richards wrote years later that the department head had responded, “Yes, I will be glad to have you, but I want you to understand you can be interne and assistant resident but you can never be resident or go any higher, no matter how good you are.”⁵⁰

In 1920 Martha May Eliot left Johns Hopkins to take a first year residency with Dr. W. McKim Marriott at the St. Louis Children’s Hospital. Initially interested in staying for another year as senior resident, Eliot gave up in disgust when, after a long talk with her mentor, she realized that “it is evident that he doesn’t want a woman as resident.—He constantly evaded the question but was very cordial about my coming back to do any type of research work I might desire.” Eliot’s only firm chief residency offer was at Detroit’s Woman’s Hospital, where a long and respectable line of women physicians had been before her. Instead, she decided to come East and begin a private practice in Boston. Later in the year she was offered a position as pediatric resident at Yale. Marriott, interestingly enough, eventually came through with the offer of a chief residency, but only after she had indicated her plans to return to Boston.⁵¹

Similarly Alma Dea Morani, the first woman to become certified as a plastic surgeon in the United States, became the first woman intern at St. James Hospital, a Roman Catholic institution in New-ark, New Jersey. A graduate of the Woman’s Medical College of Pennsylvania in 1931, she had hoped from the very beginning to become a surgeon. But even the WMCP did not encourage women in general surgery, although there were several gynecologists on the faculty who did surgery. The head of the Department of Surgery, Dr. John Stewart Rodman, was a man, and he had two male associates in preceptorship with him. Rodman had not yet trained a woman to become a surgeon. While still in medical school Morani told Rodman that she wanted surgery. After thinking about it for a year and monitoring Morani’s performance as an intern, Rodman agreed to take her on. Morani believes that she would not have had the slightest chance of becoming a surgeon if she hadn’t attended a woman’s school. Even though there hadn’t yet been any women assistants in Rodman’s tenure, Morani felt that a woman in a woman’s school at least stood the possibility of acceptance. Bertha Van Hoosen’s findings that 75 percent of the women surgeons in 1926 had either graduated from a woman’s medical school or had served as internes or residents at hospitals staffed entirely by women, corroborated Morani’s impression.⁵²

The Depression severely threatened even the slim gains that professional women had made in the 1920s. Economic dislocation, psychological disillusionment and public hostility to women working meant that women would fail to maintain their position even in the predominantly feminized fields of teaching, nursing, librarianship, and social work, where men made significant inroads for the first time. Male teachers increased from 19 percent to 24.3 percent of the total between 1930 and 1940, while the proportion of male librarians jumped from 8.7 percent to 15.1 percent during the ten-year period. Male welfare workers increased from one-fifth to one-third of all workers. Even in nursing men made such noticeable advances that the U.S. Office of Education recorded male enrollment in nursing schools for the first time.⁵³

Women had made less progress in medicine than in any of the other professions in the 1920s, and it is no wonder that this stagnant position continued throughout the 1930s. The records of AMWA and the financial struggles of the Woman’s Medical College of Pennsylvania reveal reduced incomes and some economic hardship, but no widespread unemployment among women physicians. In their study of Muncie, Indiana, however, Helen and Robert Lynd found that in the years between 1920 and 1935 the number of female physicians practicing there dropped from eight to two. The Lynds viewed this loss as directly related to the general precariousness in the 1930s of women’s professional position rela tive to men’s.⁵⁴

For all these reasons, the aspiring, woman physician in the twentieth century was hampered by professional and cultural handicaps which, though they appeared less visible than those suffered by the pioneer generations earlier, were no less effective in keeping the numbers of women doctors down to a tiny 5 percent of the profession. Unable to find social supports for maintaining a career and a rewarding family life, young women continued to turn away from a commitment to medicine when living in an atmosphere that encouraged “companionate marriage” as the most exciting and most creative endeavor available to the “modern” woman. Professional observers duly took note of young women’s reluctance to sacrifice their personal lives to medicine, and punished them accordingly by discriminating against them in advanced training: because women were expected to drop out, administrators reasoned, there was real justification in withholding from them elite internships and residencies.

This unfavorable social and professional climate made it difficult for women physicians even to hold onto what they had so painstakingly built in the previous half-century. The loss of a coherent feminist consciousness, which had provided women professionals with a supportive and stimulating intellectual atmosphere from which to draw strength, was reflected in the disquieting history of women’s medical institutions after 1930. Most illustrative of the growing ambivalence of women themselves toward separate female institutions was the manner in which the very existence of the American Medical Women’s Association persistently split women physicians over the question of separatism. The membership rolls of the organization continued to reflect a lack of interest on the part of the majority of women doctors in an organization of their own. The numbers of women who belonged to AMWA fluctuated between 9 percent and 14 percent in the decades after 1920, and the annual turnover, according to one president, Dr. Kate Karpeles, was “appalling.” The most important question that confronted the organization, she admitted in 1939, was “how to increase its membership.”⁵⁵

Leaders who made periodic attempts to drum up regional support for the organization wrote to each other in despair. “The work in this Region has been most unsatisfactory this year,” admitted Kate Hurd-Mead, regional director for New England in 1931. “I have encountered the most dull indifference despite many letters to our members asking for help and advice. There seems to be in their minds no adequate reason for meetings of medical women at present. We have very few young women practicing here, and as they are busy with their work they do not offer papers for discussion. Many of them come from co-education schools and hence think that women alone are not interesting.” Similarly, Elvenor Ernest of Kansas wrote to Louise Tayler-Jones, “This district of mine is certainly a poser. I get so discouraged sometimes that I feel like resigning my job.... The women in these states are so scattered, and women’s medical organizations, according to their view point are so unnecessary, that it is about the hardest region to handle with my very limited resources.”⁵⁶

Laments about women physicians’ lack of interest in their collective situation continued to be expressed by AMWA leaders with disquieting regularity throughout the 1940s and 1950s. In 1949, the guest editor of the Journal of the American Medical Women’s Association fretted about the wide variety of opinions among medical women regarding “our exclusively feminine professional organizations.” Some would have “us believe,” she wrote, “that we are now accepted on an equal basis with men and that maintaining such groups is not only uncalled for but highly undesirable.” Privately women physicians voiced similar worries about female complacency. “In my meeting with young physicians (most of them from co-education schools) and with young women thinking of studying medicine,” wrote Inez Philbrick on a questionnaire from the Woman’s Medical College of Pennsylvania, “I find most of them ... knowing nothing of the struggle of women to enter the profession ... and I do not find them resenting the limitation of numbers of admissions to coeducational schools, or discriminations shown therein.” Likewise, confided one past president of AMWA to another in 1952, “I have learned that women doctors are not interested in promoting other women today. The older women who penetrated the profession by carrying a high spirit of enthusiasm for a cause have disappeared, and are succeeded by those who have a spirit of complacency and secure smugness in their personal ccomplishments. ”⁵⁷

And, indeed, with many women who took medical degrees after 1920, AMWA had a distinctly negative image. Although a handful of the women physicians interviewed for the Women in Medicine Oral History Project were active in AMWA, many rejected it quite consciously. To Harriet Hardy it “seemed like an old ladies’ tea party,” and Harriet Dustan considered it “entirely inappropriate” —a “Chowder and Marching Society.” Katherine Sturgis, in spite of her connection with the Woman’s Medical College of Pennsylvania, first as a student and then as a faculty member, felt AMWA was a “biased organization.” Caroline Bedell Thomas saw it as “not pertinent” to her research-oriented career, and Louise de Schweinitz and Esther Bridgeman Clark both shied away from its perceived separatism. Beryl Michaelson, who took her medical degree in the mid-1940s, did join the association after graduation, and was for a time president of a local unit in Iowa, but the group soon fell apart, and “the individuals of the Iowa group that really wanted to continue it were so few that I lost interest.”⁵⁸

As one scans the pages of the Journal of the American Medical Women’s Association, however, it is difficult to criticize the organization too severely for its failure to attract more members. AMWA continued to struggle with issues pertinent to its constituency. Though perhaps not on a par scientifically with the New England Journal of Medicine or even JAMA, the journal featured current publications by women physicians, listed job opportunities for medical graduates, and reported medical school news, news from branches, and other important information that in a different social climate might have been considered more relevant to the lives of women physicians. The group also committed itself to legislative committee work regarding health issues of interest to women; support for the Equal Rights Amendment; service to younger women physicians and students in the form of loans, scholarships, and assistance in finding jobs, fellowships, or residencies; vocational guidance to young women contemplating medical careers; and establishing ties with women physicians abroad through the American Women’s Hospitals and a constituent membership in the International Medical Women’s Association, founded in 1942.⁵⁹

AMWA demonstrated continued willingness to investigate the status of women physicians and expose subtle and not so subtle forms of discrimination. In June 1946 JAMWA published a disturbing survey conducted by the New York Infirmary that revealed that 41.7 percent of available internships and 34.2 percent of available residencies were still closed to women medical graduates. Four months later an editorialist hailed a significant new study by two Barnard professors that sharply contradicted prevailing assumptions about the 50 percent drop-out rate of women physicians and demonstrated that roughly 90 percent of them and 82 percent of those who married remained in full-time medical work.⁶⁰

The organization also continued to tackle the question of balancing marriage, medicine, and motherhood. AMWA President Rosa Lee Nemir chastised her constituency for being too silent on the issue in a 1962 article, and pointed out that since “the majority of our members are married and have children,” the AMWA was “ideally suited as an organization to distribute information in this area. We must assure interested young women that marriage and a medical career combine not only successfully but profitably with enrichment to both.... It is time for women physicians to publicize the facts about ourselves.”⁶¹ Yet, for the most part, young women were not yet listening. Though middle-class women continued to work in increasing numbers after World War II, they were still not choosing to commit themselves to a career as demanding as medicine. Under such an unfavorable social climate, AMWA continued to speak for a tiny fraction of members within an often beleagered professional minority until feminism in the 1960s tackled the problem of the patriarchal family and exposed the hidden constraints that made it so difficult for women to balance family life and full-time careers. Only in the mid-1960s did the number of female applicants to medical school begin to rise significantly, and such change resulted directly from the revival of the feminist movement.⁶²

The professional marginality of AMWA in the 1930s, 1940s, and 1950s reflected the marginality of women physicians as a group. The AMA patronized them, controlling in gentlemanly fashion their participation in its activities. A letter from Dr. Carl Henry Davis, secretary of the AMA Section on Obstetrics, written to AMWA, President Frances Eastman Rose in 1926 exemplifies the attitude of polite tolerance which would continue to characterize these decades. Davis asked Rose to try and find “some distinguished woman physician whom you may wish to have for the Medical Women’s National Association” to present a paper before the obstetrical section at the next national meeting. “We always like to have at least one woman physician in our Section program,” Davis explained pleasantly. Neither Davis nor Rose seemed to think it odd that Davis himself knew of no such “distinguished woman” and had to appeal to the president of the AMWA to search for one.⁶³

Two other issues symbolically important to women physicians who were members of AMWA became subjects of contention between the AMWA and the AMA. The first, which was finally resolved in favor of the women, was the question of their army status, something which became an especially emotional problem after the outbreak of World War II. Many women physicians were still smarting from the cavalier treatment they had received from the surgeon general during World War I, when he refused to commission them in the armed forces. In 1939 AMWA President Nellie S. Noble again announced women physicians’ readiness to serve, and in 1940 a committee was formed to begin a registry of women physicians for emergency service. The committee unsuccessfully pressured the AMA to support the commissioning of women physicians on the same footing as men. The issue soon became a cause célèbre with the public, however, and women physicians eventually gained the support of the American Legion, the New York State Medical Society, and certain key congress-men, including New York’s Emmanuel Celler, who volunteered to introduce a bill on women physicians’ behalf into Congress. After much maneuvering and many disappointments, the Sparkman-Johnson Bill, providing for “the appointment of female physicians and surgeons in the Medical Corps of the Army and Navy,” was signed into law by President Roosevelt on 16 April 1943. By the end of the war, over 130 women physicians had served.⁶⁴

Another complaint lodged by members of the AMWA was its poor representation in the power structure of the AMA. As early as 1936 President Josephine Baker asked, “Where are the women?”, and complained that women had “practically no representation, not only in the House of Delegates, but in the appointive office” of the AMA. Though one could not join AMWA unless one first belonged to the AMA, Baker felt that women were treated as an “unconsidered auxiliary.” Three years later Emily Dunning Barringer took up the cause on behalf of the Association, proposing that a woman be appointed yearly to the AMA House of Delegates to represent women physicians as a group. The legislative body of the AMA, the House of Delegates, consists primarily of representatives drawn from state societies in proportion to their membership, as well as a few others from interest-group constituencies like the military. Raising the matter with her local New York branch, Barringer put through a resolution favoring the appointment of a woman delegate which was endorsed unanimously by the Women’s Medical Society of New York State. Then the proposal went to the House of Delegates of the Medical Society of the State of New York, where it was passed with minor changes and was brought before the AMA House of Delegates in 1939. There it was defeated on the grounds that “our women physicians are now entitled to the representation they seek, through regular channels. They have the same opportunities for selection that other members enjoy.”⁶⁵ Though AMWA attempted to reopen the question a number of times, it was only in 1983 that the AMA finally agreed to give a representative of the women’s organization a seat—though only with observer status—in its House of Delegates.⁶⁶

AMWA’s difficulties in attracting younger members and its failure to dent the power structure in the AMA persisted throughout the 1960s and early 1970s. While the reappearance of feminist activism in the 1960s prompted a frontal attack on the social values that had kept so many women in the first half of the twentieth century from seeking professional goals, AMWA lay dormant. A poll taken in 1965 revealed that only 27.2 percent of its members were under forty years of age. Most had attended medical school in the 1930s and 1940s. A year earlier AMWA’s president admitted that membership was still a “complex” problem.⁶⁷ Younger women physicians suspected that the organization was not responsive to their needs. One intern who attended a meeting observed wryly that “there was a lot of excitement and swapping of stories about injustices to women doctors during World War I.” Several of the more youthful interviewees for the Women in Medicine Oral History Project felt similarly distant from the organization. Florence Hazeltine commented, “It hasn’t been very effective for younger women; it’s mainly for older women”; and Gillian Karatinos agreed, “I never really felt a part of them.”⁶⁸

Yet feminism’s success in the 1970s began to be reflected in the rising application and acceptance statistics for women in medical schools across the country. By the middle of the decade women’s professional organizations acquired new status and prestige. AMWA was no exception. Gradually younger women at the height of their careers did join the organization, and quickly dissatisfied with what they perceived as a lack of direction, several of them forced a major restructuring of the group at its annual meeting in 1980. In Boston that year the proposed slate of officers was hotly contested from the floor for the first time in the history of the Association, and although the challenge failed, the accompanying debate resulted in the subsequent charting of a more feminist course and the inclusion of many new faces among the group’s leadership. Also significant was the hiring of a progressive executive director who had had many years experience working with the New York-based Committee of Interns and Residents. One of her first accomplishments was a communications audit of membership materials resulting in a streamlined brochure with a clearer statement of the organization’s feminist and medical goals, which was sent as a direct mailing to every woman physician in the country. This major out-reach effort has borne positive results. In 1983 regular membership increased by one-third. Although the percentage of AMWA members still remains only 8 percent of women physicians nationally, it is the strong hope of the present leadership that the Association’s concerted efforts to regionalize and encourage grass-roots support will continue to bear fruit. Certainly the sudden willingness of the AMA House of Delegates to seat even a representative-observer from AMWA after forty years of opposition to the idea represents one proof of the group’s increased visibility and political clout.⁶⁹

Equally exciting to many younger members of the Association has been the refurbished image of its journal. In 1982 a new managing editor was appointed whose philosophy was in keeping with the more feminist direction of the organization. Since then, strong efforts have been made to investigate and expose the more hidden difficulties women physicians experience balancing home and careers, as well as to provide a balanced female professional approach to some of the important health issues for women which have been raised over the last decade by the women’s movement. It is too soon, of course, to predict the long-term results of these changes for women themselves or for the profession as a whole, but what remains most significant is that such articles no longer fall on deaf ears. They reach a growing constituency of women physicians for whom these concerns are vitally important.⁷⁰

Unfortunately, the revival of the women’s movement in the 1960s came too late to preserve the integrity of other women’s institutions which had performed such important service to women physicians in the last century. The fate of two of them are worthy of brief consideration, for their stories reflect yet another dimension of women physicians’ precarious collective professional position in the twentieth century.

Because the formal and most visible barriers to women’s entrance into the profession had appeared to have dissolved by 1920, those female medical leaders who still supported separate women’s institutions were hard pressed to justify their continued existence. In 1909 Abraham Flexner had concluded that women’s choices in medical education were “free and varied.” He editorialized that “now that women are freely admitted to the medical profession, it is clear that they show a decreasing inclination to enter it.” Flexner speculated that either women were not interested in medicine, or there was no strong demand for the woman doctor.⁷¹ Moreover, he believed the women’s schools had served their purpose and were no longer necessary.

Female leaders knew better, but their arguments in defense of women’s institutions remained similar to those mustered by their predecessors in the nineteenth century. Many supporters continued to point to discrimination. Others concentrated on the special nature of women’s institutions and the important tasks that only they performed. Both positions were timeworn and familiar, and both contentions had lost their “bite” in the more complicated atmosphere of twentieth-century medical professionalism. In the case of the New England Hospital such familiar refrains proved no match for the competing exigencies created by improvements in the standardization of the medical care delivery system. The burgeoning expenses of modern hospital operaton, the ever-rising certification requirements of professional physicians, the upgrading of residency programs and their connection with university teaching facilities, the changing demographic landscape of the modern city, and the adoption by women physicians themselves of the shared values of their professional community, all contributed to a loss of allegiance to exclusively female goals.

Like many of the women’s medical institutions, the New England Hospital suffered in the twentieth century from rising costs and shrinking sources of financial aid. By 1950 it had become largely dependent on the contributions of the United Community Services—Boston’s “Community Chest”—which had given the institution roughly $60,000 a year for the last decade. Though female philanthropy had helped sustain the hospital in its first half-century, it could no longer prove adequate to the task of maintaining a modernized physical plant. As a result, the hospital, much like other hospitals in Boston, drew from new, more “modern” sources of financial aid, sources which were less interested in the hospital’s feminist past than in their assessment of its continued value in the general community.⁷²

The New England’s operating difficulties made its position precarious by the early 1950s. Economic problems worsened as its physical plant—the main building built in 1899, and enlarged in 1917 and 1931--became more and more outmoded and inefficient. Bed occupancy rates declined precipitously. While most hospitals strove for an 80 percent rate to balance the books, the New England’s occupancy rate during the 1950s was only 68 percent in medicine and surgery, 49 percent in obstetrics and 10 percent in pediatrics. Equally serious was the hospital’s resulting disfavor with young doctors seeking clinical experience. World War II had greatly increased internship opportunities for women in Boston. When Massachusetts General admitted women interns during the war years the number at the New England fell from ten to two. At one point the hospital actually offered an honorarium to women who chose to train there. The end of the 1940s brought no improvement in this situation. Inefficient facilities and few patients continued to make it difficult to recruit house staff. By 1952 the New England had only four residents and one intern. ⁷³

It is not surprising that United Community Services would choose to investigate the hospital’s deteriorating conditions. In 1949 a general survey of all the Boston hospitals it supported suggested that the New England seek to improve its image by opening its active staff to men in order to attract more patients. A year later UCS reiterated its recommendation in a new report, declaring that “the old idea of a hospital for women and children, operated by women, must be abandoned and ... the objective of the hospital should be changed to become a community hospital,” and threatening to cut off funds.⁷⁴

The ensuing decade witnessed a struggle to save the New England Hospital as a women’s institution—a struggle which divided women doctors and their supporters into two camps. Initially sympathetic with some of UCS’s demands, hospital Trustees sought to placate its critics in 1949 by dropping its designation “for Women and Children” and opening its doors to male patients. A year later, when the chief of surgery retired, she appointed a male physician in her place, and by the end of 1951 he had hired fourteen men to the surgical staff. But accepting male house staff had not yet been voted official policy, and in the meantime UCS continued to pressure the trustees about attending to the hospital’s continued financial difficulties. In 1953 Dr. Phillip Bonnet, asked by the trustees to recommend improvements in hospital services, called for a merger with another hospital in the area to improve the New England’s situation. ⁷⁵

The unofficial introduction of men onto the hospital staff, the continued insistence by the UCS that “the changed attitude of 1948 on the subject of women in medicine raises a serious question of the wisdom of continuing separate and designated hospitals in training and medical practice,” and fears that financial difficulties would ultimately force the hospital to merge, led to something of a feminist revolt. Opposing the UCS and a minority of women doctors and trustees who favored hiring men, was another trustee, Mrs. Blanche Ames, a long-time feminist and suffrage activist. As leader of the rear-guard action, Ames determined to preserve the “traditions and objectives of the founders and ... to oppose this strange resurgence of prejudice against women’s aspirations which would turn the clock backwards one hundred years.”⁷⁶

For almost a decade, supporters and opponents of preserving the hospital as a woman’s institution battled it out. But a minority of younger women physicians were quite willing to see the hospital open its facilities officially to male physicians. Women like Dr. Rosemary Nelson, a staff surgeon, contended that “the addition of men to our staff for even this short period of time ... improved” her “professional ability.” She spoke for several others as well when she claimed, “Most of us have been educated in co-educational medical schools after having competed without any concessions because of our sex, for admission. We have gained our education on an equal basis of give-and-take. I have never had a reason to feel discrimination.” The hospital, many concluded, need no longer discriminate in favor of women.⁷⁷

More popular, but less effective, were the arguments of Blanche Ames and her supporters that discrimination against women doctors still existed on all levels of medical training, that a minority of women still preferred to be treated by a woman physician, and that at a woman’s hospital “the scientific treatment of medicine is made so inconspicuous a patient hardly knows it is being carried out.” In the end, such rhetoric could not save the New England. In a social atmosphere that cherished such professional values as impartiality, rationality, and egalitarianism, a hospital dedicated exclusively to the advancement of women physicians had become an anachronism. In 1964 the New England’s bylaws were altered to accept men on its staff. Unfortunately even this change failed to save the institution, and four years later it closed its doors and became a community health center. ⁷⁸

Similar problems plagued the Woman’s Medical College of Pennsylvania. Chronically short of funds, the institution’s leadership nevertheless worked hard to upgrade its medical education. Marion Fay, later dean of the College but hired in 1935 as professor of physiological chemistry, remembers that “the question of finances was always present. This school has always had to get along on a very reduced budget, and you were conscious that many things that you wanted to do, you were hampered in trying to do them by the lack of money.” The school’s comparatively small means meant that it could not grow easily, and that well into the 1960s it would emphasize clinical education rather than research. Katherine Sturgis, for example, contemplating a medical education in the mid-1930s, sought advice from her internist, Dr. David Reisman, who was a professor of medicine at the University of Pennsylvania. When she replied “no” to his inquiry as to whether she was interested in research, he counseled, “You go up on the hill to Woman’s Medical. They’ll train you to be a good general practitioner.” ⁷⁹ The college’s achievement in turning out creditable and sometimes brilliant women practitioners becomes all the more remarkable when one contemplates the implications of several studies that suggest a positive correlation between the relative wealth of a school and the ability and success of its student body.⁸⁰

Members of the American Medical Women’s Association understood the value of the Women’s Medical College to all women physicians as a “bulwark for the future.” “I have no quarrel with them for going to other medical schools,” wrote Ellen Potter, of women who preferred coeducation, “but our continued existence is essential to them.”⁸¹ Even many male physicians respected the college’s role in preserving a place in the profession for women. In 1941 the school’s newly appointed dean, Margaret Craighill, wrote Florence Sabin of a conversation she had had with a mutual friend and male faculty member at Johns Hopkins, who “felt very definitely that the school should continue” because “the co-educational schools are so highly selective for women that only the supposed ‘super women’ have an opportunity to study medicine in them, whereas the average man can obtain this privilege. That leaves the ’average woman’ no chance to become a physician except at this school.... Many of these ... develop into better than average, and ... the record of this school is proof of this statement.” Given these realities, AMWA developed a close relationship with the Woman’s Medical College of Pennsylvania in the years after 1920, organizing a special committee to give it financial support, and publishing reports about the school in its newsletter.⁸²

But the college’s path was never easy, and was too often filled with crises. One crucial juncture occurred immediately after World War II, and involved Margaret Craighill, a Johns Hopkins graduate, who was appointed dean of the College in 1940. Though Craighill was the product of a coeducational medical school, she seemed enthusiastic about her new position. Her first accomplishment was to strengthen academic standards by reorganizing the Board of Directors. Her goal was to limit the powerful lay interference of the president, Sarah Logan Wistar Starr, a loyal supporter of the school who, according to Marion Fay, “took the place as her private charity,” and had repeatedly bailed the school out of its chronic financial difficulties since the 1930s. Craighill understood that upgrading and modernizing the college involved professionalizing and standardizing its power structure. Confronting Mrs. Starr was an important step in the right direction. She then devoted her energy to reorganizing the hospital. In 1941 she wrote Florence Sabin, “I am under the impression that you feel there is no place for a separate Woman’s Medical College. That was a very real question in my own mind when I came here last fall, but after studying it intensively for six months I have come to the conclusion that there is a needed place for such a school at present, and that with a combination of graduate study we may fill a real need for women in medicine.” Craighill was convinced, she assured Sabin, “that we can hope to put this school in a position which needs no apologies.” Also in that year, Craighill was able to involve yet another important and highly visible Johns Hopkins graduate in working to support the college—Louise Pearce, a fellow of the Rockefeller Institute since 1913. Pearce served as a member of the Board of Corporators until 1946, when she became president of the school, serving until 1951.⁸³

But before Craighill could make substantive changes, her active tenure as dean was cut short in 1943 by the passage of the Johnson-Sparkman Bill, which commissioned women physicians in the Armed Forces. Craighill became the first woman doctor to join the military and, with the rank of major in the Army, left the college temporarily to take up new duties in the Office of the Surgeon General in Washington, D.C. In her place as acting dean she chose Dr. Marion Fay, chairperson of the Department of Physiological Chemistry. Fay took the position with many reservations, fearing that she “was going to be officiating at a funeral.” Because of the war, Fay “thought very decidely that the men’s schools would be admitting many more women, and that both the quality and quantity of our applicants were bound to go down, and we would not be able to fill our class with properly qualified people.” Much to Fay’s surprise, the number of applicants “tripled and almost quadrupled” during these years as “women all over the country got much more interested in medicine.” Fay plunged good-naturedly into her new role, kept the college running smoothly, and in 1946 handed over to the returning Dr. Craighill a “practically solvent” operation.⁸⁴

In spite of the promising situation, Craighill’s first move was to negotiate secretly a merger with Jefferson Medical College. Shortly after her return, she called the Board of Corporators together and presented the arrangement as a fait accompli, arguing that it was the only way the college could survive. Stunned, Fay and a majority of faculty members, students, and alumnae revolted. In a stormy session a few days later, they voted down the entire plan, and Craighill resigned in disgust. Once again Marion Fay replaced her as dean.⁸⁵

Yet what Dean Craighill failed to accomplish in one bold stroke, the passage of time and the exigencies of medical education have achieved for her. Ironically, though Fay and her supporters fought hard in 1946 to preserve the identity of the college as a women’s institution, they won the battle but lost the war. The subsequent history of the school demonstrated that no one could stem the tide of “progress.” In the professional world of modern medicine, progress meant coeducation.

During Marion Fay’s tenure as dean from 1946 to 1963, she presided over a number of important changes at the college. Like other medical schools in the country, Woman’s Medical responded as best it could to the shifting demands of professionalization. Its faculty became full-time and salaried, money for a new research wing was secured, and the size of entering classes grew as facilities were improved. The trend towards specialization, which had accelerated after World War II, brought more and more men to faculty and administrative positions, because of women’s still limited access to specialty training. From 1950 to 1960 the percentage of women faculty declined from roughly 50 percent to 39 percent. This development so disturbed the alumnae that in 1966 they petitioned the college administration in protest, asking that the balance be restored in favor of women.⁸⁶

In 1963 Dr. Fay supported Dr. Glen Leymaster, long associated with the Council on Medical Education, as her successor. Not since the founding of the school more than a hundred years before had the deanship been held by a man. Fay argued that it was impossible to find a woman both qualified and available. Although some shared her view, other alumnae believed that she had become convinced that male leadership would be more forceful.⁸⁷

Since 1969 Leymaster has been succeeded by several new deans, all of them men. Similarly, the college has had a succession of presidents. Only in 1970 and in 1976—for one year apiece—has that office been held by a woman. The only woman physician who was interviewed for the job in 1974 speculated cautiously that her interviewers doubted whether a woman could project “the kind of image” that was needed.⁸⁸

At the time Leymaster was appointed, he had appeared to be committed to preserving the college’s identity as a woman’s institution. In 1965 he published an idealistic article that envisioned the Woman’s Medical College of Pennsylvania as a national center for educating women in medicine. Only three years later, however, he had become discouraged. Worried about the mounting difficulties of getting proper funding for an all-woman’s school, and pressured by the male faculty and members of the Board of Corporators who had little feeling for the school’s history and who felt coeducation was the only way to help their students become competent physicians, Dr. Leymaster recommended that the college admit men.⁸⁹ In 1971 six men entered the freshman class, and the school dropped the word “Woman’s” from its name and became the Medical College of Pennsylvania. Although there has remained an informal commitment to retaining large numbers of women students, the presence of males has become a significant one. By 1980 74 percent of the faculty was male, while the number of male students had increased from 6 to 40, roughly 40 percent of the entering class.⁹⁰

Marion Fay believes that the change was “inevitable.” Many agree with her that “the school’s standards have definitely been raised.” But other alumnae, emotionally attached to a school that had seemed to nurture, not dampen, their highest aspirations, lamented the passing of “Woman’s Medical.”⁹¹ Some identified strongly with Barnard graduate Laura Inselman Guy, a member of one of the last all-woman classes, when she recounted her medical school experience:

The Woman’s Medical College of Pennsylvania became coeducational in 1970 and as a result, the last woman’s medical institution ceased to exist. In the future women doctors would struggle to develop a satisfying professional identity without the intangible psychological benefits provided for so long by institutions they could, if they so chose, call their own.