This is a book about women physicians. It traces their history in the medical profession in the United States. Beginning with a discussion of the colonial period, when women were not members of the profession but participated in healing as nurses, midwives, and practitioners of folk medicine, the narrative moves to an examination of the antebellum health reform movement and its role in making public the idea that health is a female responsibility. Finally, the book describes the entrance of women into the profession and tells the story of their long struggle to become respected professionals in the eyes of male colleagues and the public at large. Because of the book’s scope and a disconcerting lack of source material, black women physicians and sectarian women have been largely passed over in this account. Each group deserves further scrutiny, and it is my hope that this study will inspire others to pursue topics which I have been forced by time and circumstance to omit.

The entrance of women into the medical profession in the nineteenth century was integrally connected to the rise of feminism. Throughout this book, feminism will be defined as broadly as possible. It will signify a movement that at its core intended to connect women in some integral way with public life. Feminism generated an extensive spectrum of public activity for women and a wide range of ideological explanations to justify that public activity. Feminists disagreed about many things. They differed, for example, over whether the best means to accomplish their goals would be to press for women’s suffrage. Some argued that the suffrage was a sine qua non of women’s full participation in the community. Others believed that women’s work would best be confined to those concerns which were most obviously “feminine”—the education of the young, the safekeeping of social morality, moral and religious uplift among the poor, municipal housekeeping, bringing the benefits of medical science to bear on family life. Most feminists, especially in the nineteenth century, believed that women should enter public life because they had a unique contribution to make that men could not. A minority of bolder thinkers claimed women’s right to participate on the grounds of equality, justice, and the critical importance of satisfying work to proper human development. Many felt that even after women gained full participation in politics, education, and the professions, they would continue to act like women and fortunately would bring their special perspective to their work. Others insisted that once women were properly exposed to public and professional life, they would learn to act more like men, and that was all to the good.

The ranks of women doctors displayed this wide-ranging diversity. Many would not have called themselves feminists. Some were unmoved by the suffrage campaign; there were even a few who opposed female suffrage altogether and spoke against it.² They disagreed over strategy and substance. One group concentrated on the building of separate institutions in order to preserve and strengthen female spheres of influence within the profession. Another wished to see women assimilate into male institutions as quickly as possible. Yet however much they differed over specific issues or strategies, women physicians expressed feminism in their behavior. Each of them sought for themselves a closer connection between woman’s traditional sphere—the family—and the larger public arena. Each of them believed that entering the professional world by becoming a physician was a perfectly legitimate choice for a woman to make.

If there was a dominant point of view among women doctors in the nineteenth and early twentieth centuries, it was that women belonged in the medical profession by virtue of their natural gifts as healers and nurturers. Most would have agreed with Dr. Ella Flagg Young when she observed that “every woman is born a doctor. Men have to study to become one.”³ By the middle of the nineteenth century, medicine appeared especially suited for women because it combined the alleged authority of science with a dedication to alleviating suffering that seemed inherently female. In a period when the family was thought to be particularly threatened by the crassness and moral depravity of a rapidly industrializing society unprepared for the burgeoning problems of poverty and disease, women physicians seemed exceptionally suited for teaching the practical tenets of family health and hygiene that would both protect and soothe an anxious public. In theory at least, they would be dedicated practitioners, oblivious to selfish motives and sensitive to the wives, mothers, and children who would be their primary constituency. They alone could combine sympathy and science—the hard and soft sides of medical practice. “Medicine is indeed a science,” Professor Henry Hartshorne reminded his female students at the Woman’s Medical College of Pennsylvania in 1872, “but its practice is an art.”⁴ To the supporters of women’s entrance into the profession, the fact that women would bring cooperation, selflessness, nurturing, purity, and social concern to their work was the strongest possible justification for the continued existence of the woman physician.

Less clearly understood at the time were other forces at work which resulted in the ascendancy of professional and scientific standards distinctly different from, and often at odds with “female” values. In the professionalizing world of late nineteenth- and twentieth-century medicine, individualism, scientific objectivity, rationality, personal achievement and careerism formed a new ethos which one historian has labeled “the culture of professionalism.”⁵ As women struggled for an equal place in medicine, they came into contact with this ethos, and, as committed professionals, dutifully upheld and transmitted its precepts. At the same time, they were segregated from the larger social milieu by their separate experience as women living in a Victorian culture which did not yield easily to the deliberate blurring of the sexual spheres. Moreover, they remained a tiny numerical minority within the medical profession. As a minority and as women, they viewed professionalism from a different and more critical perspective than the majority of their male colleagues.

Nothing illustrates these subtle tensions better than an examination of gender and medical treatment in the last third of the nineteenth century. Though women physicians believed that they differed markedly from the men in their respective therapeutic styles, few of these alleged distinctions in treatment can be found in the patient records. A comparison of obstetrical management at a male-staffed and a female-staffed hospital in Boston demonstrated only negligible differences in the administration of heroic drugs and the use of intervention techniques, such as forceps. What the records did reveal were possible differences in the subjective experience of the patients. Women physicians had more contact with their charges, they exhibited a greater concern for patients’ moral and emotional well-being, and their institutions were slower to respond to the emerging “modern” professional ethos which discarded traditional holistic methods of care in favor of more technocratic approaches.

Thus, the inherent contradictions in the position of these first generations of women physicians presented them with an interesting and sometimes painful dilemma. Which values should be given prominence? The writings of many nineteenth- and twentieth-century women doctors reveal that they believed it possible to act on both sets of principles: they could humanize society, raise the moral tone of the profession, and rationalize the family by bringing science into the home all at once. In the end they helped to accomplish only the last of these goals—the rationalization of the family. Moreover, as successive generations of young women entered medicine and learned the habits of rationality, efficiency, and the scientific method in an overwhelmingly male professional world, their distinct female vision was gradually lost.

But first, many women physicians, Elizabeth Blackwell being only the most prominent among them, successfully mounted a critique of the impersonal, dehumanized standards of scientific medicine and of the career building of modern professionalism. During periods of liberal reform, they received substantial public support for their position. From 1880 to 1930, women physicians were highly visible in this nation’s reform movements. They were particularly adept at developing programs for women and children that became an integral part of the liberal welfare state.

As the political atmosphere became hostile to liberalism in the decade after World War I, the critical vision of women physicians became a minority position. Even the period of New Deal reform was no exception to the pattern. Unprecedented economic hardship generated such a strong national outcry against working women that women professionals also suffered from public disapproval. In spite of the presence in the 1930s of a handful of women physicians like the Children’s Bureau Chief Martha May Eliot, women doctors were generally less conspicuous in New Deal reform than they were only two decades earlier. Moreover, the generations of women physicians who came of age after 1930 were trained in a medical world almost totally bereft of female-run institutions, female support systems, or a traditionally female point of view. Young women physicians learned to accept the prevailing values of the profession without wielding any real power within it.

The revival of feminism in the 1960s came in the wake of a resumption of significant public interest in liberal reform. In recent years American society has witnessed notable increases in the ranks of women in the work force. Married women with school-age children are employed in large numbers. The impressive jump in the percentage of women in professional occupations has also been striking. Women physicians have benefited in substantial ways from these developments, ranging from the dramatic increases in application and acceptance statistics at medical schools across the country, to the reemergence of a national debate on woman’s role.

Perhaps not surprisingly, reformers in the 1960s generated a good deal of criticism of the elitism and the masculine orientation of the professional ethos that had prevailed almost unchallenged in American culture since the turn of the century. In medicine especially but by no means exclusively, a new appreciation has appeared for the traditionally “female” qualities of nurturing and cooperation.

It is probably too soon to conclude that this recent admiration will result in a general reorientation of professional values. Therefore, this book will not make any predictions about the prospective role of women physicians or about the possible results of their increasing numbers within the profession. It can, however, like every good history, attempt to provide an accurate picture of their experience in the past. It is my hope that such an accounting will lend a balanced perspective to the present and will provide helpful insights in shaping the future.