VII. WOMAN IN MEDICINE. (continued 2)

Four other women became members of the Pathological Society,^[110] two of the Neurological Society,^[111] one of the Neurological Association,^[112] and two of the Academy of Medicine.^[113] No new application has been made to the Obstetrical Society, a private club. But the obstetrical section of the Academy contains one female member.^[114]

In Boston the “admission” of women was debated in three directions: to the Harvard Medical School, to the Massachusetts State Medical Society, and to the Boston City Hospital. The application of Miss Hunt to the Harvard Medical School in 1847 and 1850 have already been described. After the final discomfiture of this first applicant, no other attempt to open the college doors was made until 1879,^[115] when a Boston lady, Miss Marian Hovey, offered to give $10,000 toward the new building the college was about to erect on condition that it should receive women among its students. A committee was appointed from among the overseers of the university to consider the proposition;^[116] and after a year’s consideration reported, with one dissenting voice, in favor of accepting the conditions. The committee outlined a plan for medical co-education, substantially like that already adopted at the Michigan 186University, where certain parts of the instruction should be given to both sexes in common; for others, where embarrassment might occur, the instructions should be duplicated. The one dissenting voice, that of Le Baron Russell, disapproved of co-education in any shape, but urged that Harvard University should charge itself with providing a suitable independent school for women.

The majority report expressly advised against the establishment of a separate school for women because “A considerable number of the most highly cultivated women physicians of the country state that the same intellectual standard cannot be maintained in a school devoted to women alone, and that the intellectual stimulus obtained by female students from their association with men is an all-important element of success.”^[117]

To guide its deliberations the committee had sent questions to 1300 members of the State Medical Society, to which 712 answers were received; of these 550 were in favor either of admitting women to the school, or of providing in some way for their education and recognition. These answers helped to decide the affirmative character of the majority report. Upon its reception, the Board of Overseers recommended the Medical Faculty to accept Miss Hovey’s $10,000 and admit women to the school. But of the 21 members of the Medical Faculty, seven were strongly opposed to the admission of women, six were in favor of admitting them under certain restrictions, eight were more or less opposed but were willing to try the experiment. It was generally considered too rash an experiment to be tried, at the moment that the school was already embarked on certain improvements in its course of education, which threatened to cause a falling off in the number of its students. So the proposition was finally rejected by a vote of 14 to 4. The overseers of the university, having no actual 187control over the decisions of the Medical Faculty, were therefore compelled to decline Miss Hovey’s offer. But, in doing so, they strongly recommended as expedient that, “under suitable restrictions, women should be instructed in medicine by Harvard University.”

The defeat at Harvard in May was, however, followed by a triumph in another direction in October of the same year. On Oct. 9, 1879, an editorial in the Boston Medical and Surgical Journal says: “We regret to be obliged to announce that, at a meeting of the councilors held Oct. 1, it was voted to admit women to the Massachusetts Medical Society.”

This society is not, like that of New York and many of the States, composed of delegates from county societies, but it comprises, and indeed consists of, all the legally qualified practitioners of the State. Refusal to enroll women among its members, therefore, meant a refusal to recognize the legality of diplomas that the authority of the State had conferred. The profession, therefore, in this matter deliberately set itself above the law, a most exceptional act in American communities. A precedent for such action had previously been established when the society refused to recognize homœopathic and eclectic physicians, who also held diplomas by legal authority, inasmuch as their schools were chartered by the State. The action of the Medical Society towards women was, in fact, intended as a means of permanently relegating women among classes of practitioners pronounced inferior and unscientific, and whose legal rights merely sufficed to save them from prosecution as quacks, and to recover their fees from such persons as were foolish enough to employ them.

For twenty-five years the battle was waged, and arguments advanced pro and con, of substantially the same nature as those which have already been sufficiently quoted. A circular was sent to the 1343 members of the society, asking the following question: Do you favor the admission of women to the Society on the same terms with men? To this circular, 1132 replies were received, of which 709 were in the affirmative, 400 in the negative, while 23 were indifferent. “It was thus evident that a considerable majority of the Society, seven to four of all who answered the circular, favor the admission of women.”^[118]

In June, 1875, a committee of five was chosen from the 188society to report whether duly educated women could not be admitted to membership. In October a majority reported in favor of examining for membership men and women without distinction. But the minority objected so vigorously, that the whole matter was postponed indefinitely. In 1878, another committee was appointed: in June, 1879, the members were found equally divided; the subject was referred back to the committee, who, in October of the same year, advised no action. But this time the minority reported to instruct the censors to admit women for examination. The councilors voted, 48 to 38, to adopt the minority report.^[119]

But the end was not yet, for in February, 1880, the censors of Suffolk County (including the city of Boston), voted that the society be advised to rescind its vote of October. This, however, was never done; but, after some further delay, the first female candidate, Dr. Emma Call, a graduate from Ann Arbor, passed a satisfactory examination and was admitted. The decisive step once taken, other women passed in readily, and 1889, ten years from the date of the conclusion of the famous controversy, a dozen women sat down to the annual banquet of the society, among whom was one invited guest from another State. The “moral tone” did not seem to be “perceptibly lowered,” on this occasion.

In 1882, Dr. Chadwick published a tabulated summary of the dates at which various State societies had admitted women to membership.

In 1872, Kansas, Iowa; in 1874, Vermont; in 1875, Maine, New York, Ohio; in 1876, California, Indiana; in 1878, New Hampshire; in 1879, Minnesota, Massachusetts; in 1880, Connecticut; in 1881, Pennsylvania.

Rhode Island, Illinois, and Oregon also had women members, but the date of their first admission was not known. Thus seventeen societies contained, in 1882, 115 female members—that of New York alone having forty-two, much the largest of all.

189From this time the question of the official “recognition” of women might be regarded as settled. Another question of equal, if not greater importance, now came to the front,—namely, the extension to women of opportunities for study and practice in great hospitals, opportunities absolutely indispensable both to obtaining and maintaining a valid place in medical practice and the medical profession. The discussion of this question belongs to the seventh period of the history.

For this purpose the small hospitals conducted by women were (and are) quite insufficient. There is such a demand upon their slender accommodations and resources for obstetric and gynæcological cases, and the claims of such cases to the special advantages of these hospitals are so paramount, that they have so far tended to a specialism, which, though useful for the patients, is detrimental to the physicians who must find all their training in them. Efforts, therefore, have constantly been made to widen the range for women, by securing their admission as students, internes, or visiting physicians to the great hospitals, which constitute the medical treasure-houses of the country.^[120] In describing the actual condition of the medical schools, mention has been made of the hospital advantages which have been, little by little, secured for their undergraduate students. In Boston, where there is no school for women but the homœopathic school of the Boston University, fewer opportunities exist than anywhere else.

The Massachusetts General Hospital is reserved exclusively for the students of the Harvard Medical School. But the City Hospital remained unappropriated, and in 1886, the President and Trustees of the Boston University petitioned for permission for their female students to visit there, on the same terms as the young men. A committee was appointed to consider the matter, and after an elaborate report on the contemporary usage in ninety-one hospitals throughout the United States, advised that the request be granted. This enabled the female students to attend the public lectures given and the 190operations performed in the hospital amphitheatre about once a week.^[121]

Similar, though more frequent, opportunities for clinical instruction had been previously secured for women at the city hospitals of New York (Bellevue), Philadelphia (Blockley), and Chicago (Cook County). At the Pennsylvania Hospital in Philadelphia, moreover, the women from the Medical School had been admitted to lectures on special days, when no male students were present. These scanty privileges (for not much can be learned about a patient by spectators seated on the benches of an amphitheatre) were only obtained after a series of collisions with the men students, occasionally rising to the dignity of a row, as upon one memorable occasion at the Pennsylvania Hospital;^[122] more often consisting in petty teasings and annoyances, which bore considerable resemblance to the pranks of schoolboys. To students habituated to the daily visits in the wards of the vast European hospitals, this form of clinical instruction, where the patient studied is seen but once, and then at a distance, must seem ludicrously inadequate.^[123] From these defects, however, the male and female students suffer alike. But the former have, until recently, retained the monopoly of the hospital appointments, whereby a certain number of graduates are enabled to acquire real clinical instruction. This monopoly is only just beginning to break down.

Apparently the first general hospital in the country to confer a hospital appointment on a woman, was the Mt. Sinai Hospital of New York. Here, in 1874, Dr. Annie Angell, a graduate of the Infirmary School, was made one of the resident physicians, at the instance of several members of the medical staff.^[124]

In 1884 Dr. Josephine Walter, another graduate of the Infirmary 191School, was admitted as interne after a severe competitive examination, among nineteen candidates, of which only two could be appointed. She also served three years in the hospital, and then spent two years in Europe in medical study.

Since her appointment, none others have been made, or indeed applied for, in this or any other hospital in the city. Even in the Woman’s Hospital, with exclusively female patients, and a host of female nurses, the medical staff have repeatedly expressed their formal opposition to the admission of female internes; and the Board of Lady Managers, oblivious of the first resolution of the first founders of the hospital, have so far remained indifferent to the anomalous injustice of the situation.^[125]

Among dispensary services, however, many women have found places. Dr. Angell and Dr. Putnam Jacobi founded a dispensary at the Mt. Sinai Hospital, and for a year conducted it exclusively themselves. It was then systematically organized by the directors of the hospital, and has since always had women on the staff. In 1882, a school was open for post-graduate instruction in New York, and Dr. Putnam Jacobi was invited to a place in its faculty, as the clinical lecturer on children’s diseases, the first time a lectureship in a masculine school was ever, in this country, filled by a woman. In the same school, another woman, Dr. Sarah McNutt, was also appointed as lecturer, and founded a children’s hospital ward in connection with the school. The positions at present held by women physicians in New York dispensaries may be thus summarized, exclusive of the dispensary of the Infirmary:

Demilt Hospital, 3; Mt. Sinai Hospital, 2; St. Mary’s Hospital for Children, 1; Hospital for Ruptured and Crippled, 4; Manhattan Eye and Ear Infirmary, 1; Foundling Hospital, 1 (resident physician); Nursery and Child’s Hospital, 1 (resident at country branch); Babies’ Hospital, 1.

In Philadelphia, the Blockley Hospital, the first in the United States to allow a woman to visit its wards,^[126] appointed a female interne upon competitive examination, in 1883.^[127] Since this date, eleven other women have received such appointments,—of 192whom four in 1889. Dr. Clara Marshall and Dr. Hannah Croasdale were put on the visiting staff in 1882. Chicago, however, is the city where the hospital privileges have been most equitably distributed, though the opportunity has been obtained by a struggle rendered severe, not from the opposition of those adverse to women physicians, but from the inadequate instruction given by those who had professed to be their friends.

In 1877, an invitation was sent to the senior class to take part in the examination for internes at the Cook County Hospital. “To go meant to fail. We decided to go, if only to show how little we had been taught in surgery.” This was really an heroic determination; and the ordeal was severe. “The students and other spectators received us with deafening shouts and hisses The gynæcological and obstetrical examiners made vulgar jokes. The surgeon tried to wreck us. We forced things as best we could, but of course no one received an appointment.”^[128] As a rather unusual result of this trial, the professor of surgery at the Woman’s College was roused to exertion, and for two years taught so well, that on another competitive examination the Woman’s College was said to have stood first. However, no woman was appointed, but a relative of the commissioners, without an examination. Still the women’s pluck and determination held out; they came up a third time,—and then, in 1881,—the coveted position was gained, and a young woman only twenty-one years of age was nominated as interne. Since then, appointments have multiplied, thus:

Name of Hospital. Date of Appointment. No. of Women Physicians.

Cook County Hospital 1881 1

1888 2

1889 2

Illinois Woman’s Hospital 1882 1

1887 1

1888 1

1889 1

Wesley Hospital 1889 1

State Insane Asylum Unknown 2

Finally, it is noteworthy that Dr. Sarah Hackett Stevenson holds an appointment to the Cook County Hospital as visiting physician, and Dr. Marie Mergler a similar appointment to the Woman’s Hospital.

193A special and extremely interesting branch of the struggle for hospital positions for women physicians has related to their appointment in the female wards of insane asylums. This movement also originated in Pennsylvania, and in the personal efforts of Dr. Corson, supported, as before, by Dr. Atlee. At the annual meeting of the State Society in 1877, the following preambles and resolution were read:

“Whereas, The State Medical Society has taken a deep interest in the welfare of the insane during the last few years; and

“Whereas, The inmates of our State hospitals are in nearly equal numbers of the sexes; and

“Whereas, We have many female physicians who are eminent practitioners, and one at least^[129] who has had experience in the medical management of the insane: therefore,

“Resolved, That a committee of three persons be appointed by the president of this society, to report at its next annual meeting on the propriety of having a female physician for the female department of every hospital for the insane, which is under the control of the State.”

A committee was appointed,^[130] and reported at length in favor of the resolution. Just emphasis was laid on the fact that the very first attempts ever made to reclaim the insane asylums of the State from a condition of utter barbarism were due to a woman, Miss Dorothy Dix, whose name has been a household word in America, as that of Elizabeth Fry in England. The fact that at present there were no women who had received the special training requisite for the scientific treatment for the insane was offset by the other facts, that the existing medical superintendents were charged with the business responsibilities of the asylum, and thus had entirely insufficient time to devote to the medical care of the patients; and that the subordinates, upon whom such care practically devolved, were usually recent graduates, who were entirely destitute of special training, and indeed for whose education in psychiatry no provision anywhere existed.

A bill was drafted, to be presented with a memorial to the Legislature, making the appointment of a female superintendent 194obligatory in all asylums with female patients. The legislative committee returned the bill to the House with an affirmative recommendation.

A counter memorial was, however, sent to the Senate judiciary committee, protesting against the appointment of a female superintendent as liable to cause clashing in the management of the asylum. The memorial said that assistant female physicians could already be employed wherever deemed expedient. The memorial was so copiously signed as to suggest that much other opposition than that of superintendents, dreading collision, had been marshaled to defeat the proposed law.^[131]

Another counter thrust, however, was given by the trustees of the State Lunatic Hospital at Harrisburg, who warmly supported the bill. Before the adjournment of the Legislature, the bill was in fact enacted, but so altered that the trustees are not obliged to appoint a woman chief physician, but only empowered to do so. At this same time, a new hospital for the insane was opened at Norristown, not far from Philadelphia; and to this Dr. Alice Bennett, a graduate of the Woman’s Medical College of Philadelphia, was elected by the trustees as chief physician of the female department. Dr. Annie Kugler was appointed assistant. Three months later, in September, 1880, the trustees of the asylum at Harrisburg elected Dr. Margaret Cleaves to a position as assistant.^[132] Legislative action analogous to that initiated in Pennsylvania was not long afterward taken in Massachusetts and Ohio, and finally, during the current year, 1890, in the State of New York.^[133]

In New York, the bill required the employment of a woman physician in every State insane asylum where women are confined. It passed with only two negative votes in the Assembly, and three in the Senate.^[134]

195Previous to the enactment of this law, however, women assistants had served for a year at the Willard Asylum for the chronic insane,^[135] and in 1888, two other women, Dr. Steadman and Dr. Wakefield, were appointed in the New York City Asylum on Blackwell’s Island. Similar appointments have been voluntarily made in ten other States, and more than twenty women are now serving as physicians in insane asylums.^[136] The latest appointment was the greatest innovation, for it was in a Southern State, Virginia, at Staunton, and a Southern candidate, Miss Dr. Haynes, was appointed.^[137] The Springfield Republican concludes its notice of this event (see note), with the remark: “This reform is steadily advancing, and it will not be long before the opposition to it will be as obsolete as it is now indecent.”^[138]

Thus the last word, (so far) like the first in this long controversy, is indecency. And it is characteristic of the world-old social position of women that it should be so; since women have in the mass, never been publicly and officially regarded as individuals, with individual rights, tastes, liberties, privileges, duties, and capacities, but rather as symbols, with collective class functions, of which not the least was to embody the ideals of decorum of the existing generation, whatever these might happen to be. These ideals once consigned to women, as to crystal vases, it became easier for men to indulge their vagrant liberty, while yet leaving undisturbed the general framework 196of order and society. But all the more imperative was it, that the standard of behavior, thought, and life for women should be maintained fixed and immovable. Any symptom of change in the status of women seems, therefore, always to have excited a certain terror. This is analogous to the fierce conservatism of savage communities, ready to punish by death the slightest deviation from established custom, because, as Mr. Bagehot observes, without such strenuous care their entire social structure is liable to fall to pieces. It is perfectly evident from the records, that the opposition to women physicians has rarely been based upon any sincere conviction that women could not be instructed in medicine, but upon an intense dislike to the idea that they should be so capable. Failure could be pardoned them, but—at least so it was felt in anticipation—success could not. Apart from the absurd fear of pecuniary injury, which was only conceivable so long as women were treated, not as so many more individuals in the community, but as a separate class, and a class alien to men of their own race and blood and even family,—apart from this consideration, the arguments advanced have always been purely sentimental. There has always been a sentimental and powerful opposition to every social change that tended to increase the development and complexity of the social organism, by increasing the capacities and multiplying the relations of its members. The opposition to women physicians is, in its last analysis, only one of the more recent manifestations of this universal social instinct. So true is this, that in the strife physicians have abandoned the sentiments proper to their own profession, and have not hesitated to revile and defame it, in order to prove that it was unfit for the delicacy or virtue of woman. They have forgotten the tone of mind, the special mode of vision that becomes habitual to every one who has really crossed the threshold of the sublime art; they have talked of “revolting details” and “disgusting preliminaries,” like the veriest outside Philistine. There are horrors in medicine, because there are horrors in life. But in medicine these are overcome or transformed by the potency of the Ideal; in life they must be borne unrelieved. The women, who, equally with men, are exposed in life to the fearful, the horrible, the disgusting, are equally entitled to access to those regions of knowledge and ideas, where these may be averted, or relieved, or palliated, or transformed.

Again: A mother occupied with her young child offers a spectacle so beautiful and so touching, that it cannot fail to 197profoundly impress the social imagination. Contemplating this, it is easy to feel that all the poetry and romance, all the worth and significance of women are summed up in the exquisite moments of this occupation; easy to dread the introduction of other interests lest the women be unduly diverted from this, which is supreme. Yet nothing is more obvious than that diversion comes, a thousand times, from frivolity, but never through work; and that these moments are preceded by many years, and followed by many years, and for many women, through no fault of their own, never come at all. The seventy years of a life-time will contain much waste, if adjusted exclusively to the five or six years of even its highest happiness. The toiling millions of women of every age of the world have not been permitted to make such an adjustment, even if they should wish to do so. They have always worked; but they demand now, and simply, some opportunity for a free choice in the kind of work, which, apart from the care of children, they may perform. The invasion of the medical profession is one of the more articulate forms of this demand.

Although, according to the census of 1880, there were 2432 women registered as physicians throughout the United States, and several hundred must have graduated in the last ten years, it is probable that many of them have received an education too irregular and imperfect to justify their claim to the title in any serious sense. Thus the numbers are still too small, the time too short, to begin to estimate the work of women physicians. A large number of the women recorded in the census tables will not be found among the graduates of any suitable colleges, or on the registered lists of regular physicians, and these cannot be counted in an estimate like the present. Thus the census of 1880 records 133 women physicians in New York, but the medical register of ten years later contains the names of but 48. There seem to be about fifty at present in Philadelphia, twenty or thirty in Boston. Eighteen are said to be practicing in Detroit. The great majority are scattered through the country in small towns or country villages.

It is irrelevant to inquire with Waldeyer, “What women have done?” from the scientific standpoint, because the problem given was to enable them to become observant, faithful, and skillful practitioners of medicine, and this is possible without the performance of any really scientific work.

It is premature to make such inquiries, except for single cases which serve to illustrate the possibility, for it is but little more 198than a generation that the first school was opened to women; it is not more than a dozen years since the official education attainable has approached any degree of effectiveness. What women have learned, they have in the main taught themselves. And it is fair to claim, that when they have taught themselves so much, when they have secured the confidence of so many thousand sick persons, in the teeth of such vigorous and insulting opposition, and upon such scanty resources and such inadequate preparation; when such numbers have been able to establish reputable and even lucrative practice, to care for the health of many families over long terms of years, to sustain medical institutions of their own, almost exclusively dependent upon the good-will of citizens who have closely watched their work,—to serve in public hospitals in competition with men, to care for many thousands of sick poor, to whom abundant other medical aid was accessible, had it been preferred,—to restore to health many thousand women who had become helpless invalids from dread of consulting men physicians, or from delay in doing so,—to hold their own in private practice, in matters of judgment, diagnosis, medical and operative treatment, amidst the incessant and often unfair rivalry of brother competitors,—to do all this, we repeat, itself demonstrates a very considerable, indeed an unexpected amount of native ability and medical fitness on the part of women. With longer time, with more solid and varied opportunities, and with extension to the many of those which have hitherto been shared only by a very few, the amount of work accomplished may certainly be expected to increase, and in geometrical progression.

It could be wished that space remained to bring to light the obscure heroisms of the many nameless lives, which have been expended in this one crusade. It has been fought, and modestly, in the teeth of the most painful invective that can ever be addressed to women,—that of immodesty. Girls have been hissed and stampeded out of hospital wards and amphitheaters where the suffering patient was a woman, and properly claiming the presence of members of her own sex; or where, still more inconsistently, non-medical female nurses were tolerated and welcomed. Women students have been cheated of their time and money, by those paid to instruct them: they have been led into fields of promise, to find only a vanishing mirage. At what sacrifices have they struggled to obtain the elusive prize! They have starved on half rations, shivered in cold rooms, or been poisoned in badly ventilated ones; they have often borne a triple load of ignorance, poverty, and ill health; when they were not 199permitted to walk, they have crept,—where they could not take, they have begged; they have gleaned like Ruth among the harvesters for the scantiest crumbs of knowledge, and been thankful. To work their way through the prescribed term of studies, they have resorted to innumerable devices,—taught school, edited newspapers, nursed sick people, given massage, worked till they could scrape a few dollars together, expended that in study,—then stepped aside for a while to earn more. After graduating, the struggle has continued,—but here the resource of taking lodgers has often tided over the difficult time.

These homely struggles,—the necessity in the absence of State aid, of constantly developing popular support and sympathy for the maintenance of the colleges and hospitals, has given a solidity, a vitality to the movement, which has gone far toward compensating its quaint inadequacies and inconsistencies. On the European continent, the admission of women to medical schools has depended on the fiat of government bureaus, prepared in this matter to anticipate a popular demand, and to lead rather than to follow public opinion. In America, as in England, the movement for such extension of privilege has sprung from the people, it has fought its way,—it has been compelled to root itself in popular sympathy and suffrage. Hence a feeling of enthusiasm widely diffused among the women students, the sense of identification with an impersonal cause, whose importance transcended that of their individual personal fortunes, and yet which could only be advanced by the accumulation of their individual successes. The ill-taught girls at Chicago, who, sure in advance of defeat, resolved to face ridicule and contempt at the competitive examinations, in order to make a road for their successors, really exhibited, in a moral sphere, the heroism of Arnold Von Winklereid on the old Swiss battlefield.

The change from the forlorn conditions of the early days has been most rapid, and those who survived the early struggle, and whose energies were not so absorbed by its external difficulties that not enough were left for the intrinsic difficulties of medicine, have been really invigorated by the contest. Indeed one of the ways in which women have secured the infusion of masculine strength essential to their success, has been by successfully resisting masculine opposition to their just claims. It is as in the fable of Antæus,—those knocked down to the earth gained fresh strength as they touched the ground. The character and self-reliance natural to American women 200have thus been reenforced even by the adverse circumstances of their position. And, conversely, those for whom circumstances of fortune and education have been apparently the most propitious, even those who have received the best theoretical education, have not unfrequently been distanced, or even dropped altogether out of the career, because of an incurable dilettantism, for which the remedy had not been found either in practical hardship or in native intellectual vigor.

Efforts have several times been made to estimate the actual proportion of markedly successful practitioners among the women now engaged in medicine.^[139] The two monographs cited below are both based upon circulars of questions sent out to as many women physicians as possible.^[140] The answers to these inquiries are necessarily very partial, and can be quoted rather as illustrations than as statistics. Among such illustrations, the statements of the pecuniary results of practice are interesting. Dr. Bodley received answer from 76 ladies, and their total annual income, if divided equally among the 76, amounted to about $3000.^[141] Among these, however, ten earned between $3000 and $4000 a year, five between $4000 and $5000, three between $5000 and $15,000, and four between $15,000 and $20,000.

In Dr. Pope’s paper, 138 women reported on their income, and out of them only eleven had then practiced over two years and failed to become self-supporting. Another item of interest is, that 32 per cent. of these women report that they have one or more persons partially or wholly dependent on them.^[142]

201So great are the imperfections, even to-day, of the medical art, so numerous all the difficulties of applying even all existing resources, so inevitable are the illusions in regard to the real cause of either success or failure, that it is the most difficult thing in the world to estimate the intrinsic ability of a physician, even by his success in practice. A large practice certainly always testifies to some kind of ability; but this is not always strictly medical. The essential test is that of accuracy in diagnosis, and this test cannot, by means of any public documents accessible, be applied. Its successful application can only be inferred by the gradual development of confidence in women, both among the more intelligent and critical of the laity, and among the more unbiassed of the professional observers, who, in consultations, have had ample opportunity to scrutinize diagnoses.^[143] For a dozen years it has become customary in America for the most distinguished members of the profession, even in large cities, to send patients to women physicians, in any case where the circumstances of the illness lead the patient to prefer a woman.^[144] The same is done when, from personal acquaintance, or on account of public reputation, the patient has confidence in some special woman physician, and desires her counsel therefore, for other reasons than those of delicacy.

The women physicians of America share, while rather intensifying, the main characteristics of their medical countrymen. They have, as a rule, little erudition; but they have great capacity for bringing to bear all available and useful knowledge upon practical issues. They certainly do not read enough; and there is, therefore, a noticeable thinness in their discussions of medical topics when they meet in isolated council. But they have a resolute helpfulness in dealing with the individual cases entrusted to their care, and a passionate loyalty to those who have put their trust in them. They are possessed of abundant motive power for concrete intellectual action, though they might lack this power, if the work depended exclusively on abstract intellectual interest. And, after all, it is this habit of mind which most distinctively marks the modern practicing 202physician, and without it the advances in medical science would be of little profit to the sick; indeed, would often not be made. And, what is often overlooked, it is precisely these mental habits here described which have been usually considered as particularly characteristic of women. Thus the introduction of women into medicine demands no modification of the typical conception traditionally held of women, but only an enlargement of the applications which may be made of this characteristic type.^[145]

In nothing are popular views about women more at variance with fact than in regard to their capacity for operative surgery. The popular conception of surgery is itself entirely false, being inherited from a by-gone period, when hospital operations were conducted in the wards, filled with shuddering patients awaiting their own fate; amid clouds of steam from burning irons, torrents of blood, and the groans and shrieks of the victim.^[146] But to-day, with anæsthetics, hæmostatics, and antiseptics, the surgeon may operate as calmly as on an insensible wax figure; and, moreover, with a reasonably correct technique, be assured of success in a vast majority of cases whose result was formerly, even under the best skill, always doubtful. The very greatness of the achievements of surgical genius have lessened the amount of ability requisite to perform many surgical operations; and especially have the modern conditions of operating removed the perturbating influences which female nerves might be supposed unable to resist. Moreover, the technique has become so precise that it can be taught; and women, even when defective in power of original thought, are extremely susceptible of being trained by exact drill. On this very account the model of a practical medical school should be that of a military academy, where every operation, mental or manual, that the graduate is subsequently expected to perform, will be rehearsed before graduation.

Now the remarkable thing about women surgeons is, not that 203they have learned how to operate when they have been taught, but that, with very insufficient teaching for the most part, they have contrived to learn so much, and to operate so successfully. Obstetrics and gynæcology have here again offered peculiar advantages, in presenting a series of cases for operation which vary from the most trifling^[147] to the most serious capital operations in surgery. The latter have only been attempted in the last decade, and it is worth while to quote such statistics as I have been able to obtain, even though they are necessarily incomplete:

New York Infirmary: From 1875 to 1890; 535 operations (29 laparotomies); operators, chiefly Dr. Elizabeth Cushier, but in a smaller number of cases, Drs. Blackwell, Peckham, McNutt, Putnam Jacobi.

New England Hospital: From 1873 to 1890; 829 operations (48 laparotomies); operators, Drs. Dimock, Buckel, Keller, Berlin, Whitney, Smith, Crawford, Bissell, Kellogg, Angell, Pagelson.

Chicago Hospital: From 1884 to 1888; 206 gynæcological, 114 general surgery. Dr. Mary Thompson operated on all the gynæcological cases, except four; the report does not state whether she also operated on the others.

The reports of the Philadelphia Hospital do not give the total number of operations performed in it, but through the kindness of Dr. Fullerton, resident physician, I have received a report of the capital operations, nearly all abdominal:

Women’s Hospital, Philadelphia: From 1876 to 1889; 91 operations (all laparotomies, including several Cæsarean sections). Operators, chiefly Dr. Anna Broomall; for a small number of cases, Drs. Croasdale and Fullerton.^[148]

In addition to the above, Dr. Marie Werner of Philadelphia reports 23 laparotomies from private practice.

Other personal statistics I have not been able to obtain. Some are quoted in the list of Literature.^[149] These statistics, 204though still on a small scale, are, for the time in which they have accumulated, and for the extremely meagre opportunities which have been so far afforded, not at all unsatisfactory.

Written contributions to medical literature are also, though not abundant, at least sufficient to prove that “the thing can be done.” The 145 citations made in the list^[150] all belong to the period ranging between 1872 and 1890, a period of eighteen years.

The intellectual fruitfulness of this period is not to be compared with that exhibited by other and contemporary classes of medical workers, but rather with that of the first 150 or 200 years of American medicine. For, until now, it is a mentally isolated, a truly colonial position, which has been occupied by the women physicians of America. When a century shall have elapsed after general intellectual education has become diffused among women; after two or three generations have had increased opportunities for inheritance of trained intellectual aptitudes; after the work of establishing, in the face of resolute opposition, the right to privileged work in addition to the drudgeries imposed by necessity, shall have ceased to preoccupy the energies of women; after selfish monopolies of privilege and advantage shall have broken down; after the rights and capacities of women as individuals shall have received thorough, serious, and practical social recognition; when all these changes shall have been effected for about a hundred years, it will then be possible to perceive results from the admission of women to the profession of medicine, at least as widespread as those now obviously due to their admission to the profession of teaching.

Note.—While these pages are passing through the press, the important announcement is made that the trustees of the Johns Hopkins University—in view of a gift of $100,000, presented by women to the endowment fund of the medical department,—have consented to admit women to the medical school of the Johns Hopkins Hospital, so soon as that school shall be opened. This is the first time in America that any provision for the medical education of women has been made at a university of the standing of the Johns Hopkins. It is expected that the medical education of the future school will be especially directed for the benefit of selected and post graduate students, for such as desire to make special researches and to pursue advanced studies in medical science. The admission of women to a share in these higher opportunities is a fact of immense significance, though only a few should profit by the advantage, the standing of all will be benefited by this authoritative recognition of a capacity in women for studies, on this higher plane, on equal terms and in company with men.

205The directors of the Johns Hopkins have in this matter shown the broad and liberal spirit which befits the noble trust they are called upon to administer. It is characteristic of America that the stimulus to the trustees’ action came from without the university, from the initiative of women. This time, women have not only asked but they have at the same time given. The $10,000 gift originally offered by Miss Hovey to Harvard on condition of its admitting women, and declined by its medical faculty, has been enrolled in the gift now accepted by the Johns Hopkins. Half of the whole donation is the noble gift of one woman, Mary Garrett,—daughter of one of the original trustees of the Johns Hopkins University. The formation of committees among women in all the principal cities of the United States, for the purpose of raising money for the woman’s part of the endowment fund, and even for the remaining amount needed to open the school, is itself a most important fact, for it indicates that interest in the intellectual advancement of women, and especially interest in the success of women in the medical profession, has at last become sincere and widespread in quarters where hitherto it has been entirely and strangely lacking.

Hardly had we pronounced the present position of women in medicine to be “colonial,” when, by a sudden shifting of the scene, barriers have been thrown down that seemed destined to last another half century; an entire new horizon has opened before us. Sic transit stultitia mundi.

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