Part 18
Hospital staff: Resident physician, 1; advisory physicians, 3; visiting physicians, 3; visiting surgeons, 3; internes, 6. In-patients for year, 376; Dispensary patients, 3175.
In 1865, a fourth hospital for women and children was organized in Chicago, “at the request and by the earnest efforts of Dr. Mary H. Thompson, the pioneer woman physician in the city. Opened just at the close of the war, many of those to whom it afforded shelter, nursing, and medical attendance were soldiers’ wives, widows, and children, and women whose husbands had deserted them in hours of greatest need. There came from the South refugees both white and colored.”[81] Thus in the West as in the East, we find repeated for the women physicians of the nineteenth century the experience of the men of the eighteenth; it was amidst the exigencies of a great war that their opportunities opened, their sphere enlarged, and they “emerged from obscurity” into the responsibilities of recognized public function.
In 1871, just as money had been collected to purchase a better house and lot for the small hospital, the great fire occurred; and when after it, “the remnants were gathered together, they were found to consist of one or two helpless patients, two housemaids, a nurse, a pair of blankets, two pillows, and a bit of carpet.”[82] The hospital “remnant,” however, profited with others by the outburst of energy which so rapidly repaired misfortune and rebuilt the city. In 1871, a building was purchased by the Relief and Aid Society, for $25,000, and given to the hospital, on conditions, one of which was that it should annually care for twenty-five patients free of charge.
During the first nineteen years of its existence, up to 1854, over 15,000 patients had been cared for by the hospital, of which 4774 were house patients, 9157 were treated in the dispensary, and 1404 attended at home. The report of the hospital for 1888 gives a summary for four years.[83] There is a hospital staff, comprising attending physicians, 5; pathologist, 1; internes, 3. Annual average from four years summary: in-patients, 334; dispensary, 806; visited at home, 138.
The fifth woman’s hospital was opened in San Francisco in 1875, under the name of the Pacific Dispensary, by Dr. Charlotte Blake Brown and Dr. Annette Buckle, both graduates of the Philadelphia school. During the first year, it contained but six beds. To-day, after fifteen years’ untiring work, the enlisted sympathies of generous friends have developed it to a hospital for 110 beds, to which sick children are admitted gratuitously, and adult female patients on payment of a small charge. It is under the care of six attending physicians, who serve in rotation.
Finally, in distant Minneapolis, a sixth hospital has sprung up in 1882. At its latest report, only 193 patients had been received during the year. But the history of its predecessors, and the irresistible Western energy of its friends, predict for this a growth perhaps even more rapid than that possible in cities in the East.
It is worth while to summarize the actual condition of these six hospitals in a tabulated form:
═══════════════╤═══════╤═════╤═══════════════╤══════════╤═══════════╤═════════ NAME. │DATE OF│CAPA-│ NO. ON STAFF. │ANNUAL NO.│ANNUAL NO. │ ANNUAL │ORIGIN.│CITY.│ │ IN- │DISPENSARY.│NO. OUT- │ │ │ │PATIENTS. │ │PATIENTS. ───────────────┼───────┼─────┼───────────────┼──────────┼───────────┼───────── New York │ 1857 │ 35│3 visiting │ 342 │ 4,825│ 768 Infirmary. │ │ beds│ physicians. │ │ │ „ │ │ │3 internes, 3 │ (report │ │ │ │ │ associates. │for 1889) │ │ „ │ │ │1 resident. │ │ │ „ │ │ │1 out- │ │ │ │ │ │ physician. │ │ │ ───────────────┼───────┼─────┼───────────────┼──────────┼───────────┼───────── Woman’s │ 1862 │ 47│6 visiting. │ 583 │ 6,365│ 695 Hospital, │ │ beds│ │ │ │ Philadelphia.│ │ │ │ │ │ „ │ │ │6 internes. │ (report │ │ │ │ │ │for 1889) │ │ „ │ │ │1 resident. │ │ │ „ │ │ │12 district. │ │ │ ───────────────┼───────┼─────┼───────────────┼──────────┼───────────┼───────── New England │ 1863 │ 58│6 visiting. │ 376 │ 3,175│ Hospital. │ │ beds│ │ │ │ „ │ │ │6 advisory. │ (report │ │ │ │ │ │for 1889) │ │ „ │ │ │6 internes. │ │ │ ───────────────┼───────┼─────┼───────────────┼──────────┼───────────┼───────── Woman’s │ 1865 │ 80│5 visiting. │ 354 │ 806│ 138 Hospital, │ │ beds│ │ │ │ Chicago. │ │ │ │ │ │ „ │ │ │3 internes. │ (average │ │ │ │ │ │ of │ │ │ │ │ │collective│ │ │ │ │ │report for│ │ │ │ │ │ 4 years) │ │ „ │ │ │1 pathological.│ „ │ │ ───────────────┼───────┼─────┼───────────────┼──────────┼───────────┼───────── Hospital for │ 1875 │ 110│6 attending. │ │ │ Sick Children│ │ beds│ │ │ │ and Women, │ │ │ │ │ │ San │ │ │ │ │ │ Francisco. │ │ │ │ │ │ „ │ │ │2 specialists. │ │ │ „ │ │ │2 internes. │ │ │ ───────────────┼───────┼─────┼───────────────┼──────────┼───────────┼───────── Northwestern │ 1882 │ │4 visiting. │ 193 │ │ Hospital, │ │ │ │ │ │ Minneapolis. │ │ │ │ │ │ „ │ │ │ │ (report │ │ │ │ │ │for 1889) │ │ ───────────────┴───────┴─────┴───────────────┴──────────┴───────────┴─────────
Thus, total number of women physicians engaged in six hospitals, 94; number renewed annually, 32; annual number indoor patients, 1828; annual number of dispensary patients, 15,171; annual number patients treated at home, 1601; total number patients, 18,600.
This represents the growth since 1857, when the only hospital conducted by women, in this country, was the lying-in ward of the New York Infirmary, containing twelve beds.
The foundation of these hospitals effected the transition for women physicians from the pre-medical period, when medical education was something attempted but not effected, to a truly medical epoch, when women could really have an opportunity to engage in actual medical work. Correlatively the theoretic education began to improve. In Boston, the Female Medical College was happily extinguished as an independent institution. In Philadelphia, the Faculty gradually struggled free of its inefficient or objectionable members, utilized its legacy of $100,000 to fully equip its beautiful college building, with amphitheatres, lecture rooms, and even embryo laboratories, museums, and libraries,—enlarged its corps of instructors until they numbered twenty-three, instead of the original and meagre seven,—and even, though more timidly, began to enforce something like a rigid discipline among its students, in regard to conditions of admission, examination, graduation, and terms of study. In 1885, Lawson Tait, the famous English surgeon, described the college building as “being very large and splendidly appointed. Last year twenty-six degrees of doctor of medicine were granted by the Faculty, and from the perusal of the curriculum, as well as from conversation with some of the graduates, and from discussion with both the friends and opponents of the school, I am quite satisfied that its graduates are quite as carefully trained as those in any other medical school. When I tell you that last winter 132 students matriculated in this school, that the amphitheatre in the hospital is large enough to seat 300 persons, and that every year about 4000 patients pass through this amphitheatre in the college clinics, I shall have said enough to prove to you that in the United States the practice of medicine by women has become an accomplished fact.”[84]
In New York, after much hesitation, a charter was obtained in 1865 for the establishment of a medical college in connection with the Infirmary. “This step was taken reluctantly, because the desire of the trustees of the Infirmary, of Drs. Elizabeth and Emily Blackwell, was not to found another medical school, but to secure the admission of women to the classes for instruction already organized in connection with the medical charities of the city, and to one at least of the New York medical colleges.... The demand of women for a medical education had resulted in the founding of small colleges in different places, all, with the exception of the Philadelphia School, limited to the narrow and cheap standard of legal requirements, and producing equally cheap and narrow results in the petty standard of medical education they were establishing among women students.[85] Application was made to the College of Physicians and Surgeons for advice, and the case was laid before the Faculty. It was stated that a sufficient number of women were studying medicine to show that there was a demand for instruction that must be satisfied; that the standard of education was so low that incompetent women were in possession of degrees, while competent women could not obtain the thorough instruction they desired, and those who were fitted to do good work had to contend, not only against popular and unjustified prejudice, but against the justified prejudices of those who saw the slipshod work of ignorant graduates from women’s medical colleges.”[86] The trustees proposed to the College of Physicians and Surgeons, the oldest and most reputable in New York, that they receive a limited number of female students on scholarships established by the Infirmary, to the amount of $2000 a year. This proposition was rejected, and the opinion expressed, in no unfriendly spirit, that the ends proposed were only to be obtained by establishing an independent school for women in connection with the Infirmary.
The establishment of such a school called for money,—but the money was forthcoming. A new building was purchased for the hospital; the old one, which had done such modest but effective work, was surrendered to the use of the college, and a prospectus issued announcing the requirements of the latter. In this prospectus a bold attempt was made to outline a scheme of education, which should not only satisfy the conventional existing standard, but improve upon this. It was realized, and, oddly enough, for the first time, that the best way to compensate the enormous disadvantages under which women physicians must enter upon their work, was to prepare them for it with peculiar thoroughness. Women students were almost universally deficient in preliminary intellectual training: their lesser physical strength rendered a cramming system more often dangerous to health, and more ineffective as a means of preparation; and the prejudices to be encountered in their medical career would subject them not only to just, but also to abundant unfair criticism. Instead, therefore, of the senseless official system which then everywhere prevailed, it was proposed to establish a three years graded course, with detailed laboratory work during the first years, and detailed clinical work during the last. A chair of hygiene was established for the first time in America, and an independent board of examiners was appointed consisting of professors from the different city schools. By this means the college voluntarily submitted itself to the external criticism of the highest local authorities. When the Infirmary put forth this prospectus, drawn up by the Drs. Blackwell, no college in the country required such a course: it was deemed Quixotic by many medical friends, and several of its features were for a time postponed. The independent board of examiners, however, was established from the beginning, and, little by little, the other parts of the scheme were realized. In 1876, the three years graded course, at first optional, was made obligatory. At this time no college but Harvard had taken this step. The next year the class fell off one-third,—a curious commentary on the character or circumstances of the students.[87] In 1881, the college year was lengthened to eight months, thus abandoning the time-honored division of a winter and spring course, the latter comparable to the Catholic works of supererogation, and equally neglected. At the same time entrance examinations were established. These moderate improvements upon the naïve barbarism of existing customs again reduced the classes one-half. When people first began to think of educating women in medicine, a general dread seemed to exist that, if any tests of capacity were applied, all women would be excluded. The profound skepticism felt about women’s abilities, was thus as much manifest in the action of the friends to their education as in that of its opponents. But by 1882, the friends dared to “call upon those who believe in the higher education of women, to help to set the highest possible standard for their medical education; and upon those who do not believe in such higher education to help in making such requirements as shall turn aside the incompetent,—not by an exercise of arbitrary power, but by a demonstration of incapacity, which is the only logical, manly reason for refusing to allow women to pursue an honorable calling in an honorable way.”[88]
“A career is open to women in the medical profession, a career in which they may earn a livelihood; a career in which they may do missionary work among the poor of our own country, and among their own sex in foreign lands; a career that is practical, that is useful, that is scientific.”[89]
Even when a theoretic demand is not entirely realized in the actual facts of the case, its distinct enunciation remains a great achievement; and, in an almost mysterious way, constantly tends to effect its own ultimate realization. And so it has been here.
During the current year, the college has emerged from its original chrysalis condition within the inconvenient precincts of a private house building, and entered upon a new phase of existence in a suitable building especially erected for its needs. The money for this building was collected from private subscriptions, by the indefatigable exertions of the friends of the college, and may be said to some extent to measure the growth of interest in the medical education of women, which had become diffused through the community.
In the West, two medical schools for women were opened in the same year, 1869; in Chicago a separate women’s school; in Michigan the medical department of the State University.
The State University was founded and controlled by the State Legislature. On this account, in accordance with a principle generally recognized in the West, the youth of both sexes are equally eligible to its schools, as being equally children of the citizens who support the schools by means of taxation.[90] The application of this simple principle to the medical school at once solved the question of “medical co-education of the sexes,” which had been such a bugbear in the East. The difficulties which had elsewhere been considered so insolvable, were arranged in the simplest manner. In regard to all subjects liable to create embarrassment, if discussed before a mixed audience of young students, the lectures were duplicated, and delivered to the male and female students separately. These were thus a double course for obstetrics, gynæcology, and some sections of internal medicine and surgery. The lectures, lecturers, and subsequent examinations of the students were, however, identical, and the clinics are held in common.
The value to women of this State recognition, and of opportunity to study at a university school, was immense. There were numerous disadvantages due to the youth and undeveloped character of the school, and still more to its control by a popular legislature, unversed in the requirements of learned professions. Yet there was promise of indefinite growth in the future, and in all the development of the future, women might hope to share.
At first the course of instruction was limited to two years; it has lately been extended to three; though it still has the serious defect of demanding no thesis from students as a condition of graduation. Clinical instruction has been necessarily inadequate in a small country town. It has been lately proposed to transfer this part of the curriculum to Detroit, where large hospitals furnish clinical material in abundance.
In Chicago, application to admit women was made in 1865 to the Rush College, where Emily Blackwell had studied during the winter of 1851. The appeal was refused.
In 1868, application was made at a rival school, the Chicago Medical College, and was accepted. For a year female students attended the lectures and clinics in company with young men. “The women,” observes a Chicago writer, “were all right; but the men students were at first embarrassed and afterwards rude. The mixed classes were therefore abandoned, but the woman’s movement, being essentially just and correct,”[91] was not abandoned, but led to the founding of a special school for women in 1869.
The pioneer woman physician in Chicago was Dr. Mary H. Thompson, who, having graduated at Philadelphia, and spent a year as interne at the New York Infirmary, settled in the West in 1863. At this period she was often introduced as a curiosity. Western curiosity, however, is rarely ill-natured, and in this case was soon exchanged for respect and a substantial sympathy, which enabled Dr. Thompson to establish the Hospital for Women and Children. In 1869, when the medical school was opened for women, its students found in this little hospital their first opportunities for clinical instruction. From 1869 till 1877, the collegiate course was conducted in a “small two-story building containing a dissecting room and one little lecture room furnished with two dozen chairs, a table, a portable blackboard, and a skeleton. There were scarcely any means for practical demonstration in the lectures, there was no money to procure them.”[92] Worse than all, several among those who had consented to teach the students seemed, strangely enough, to have done all they could to discourage them. “One lecturer only delivered two lectures in the entire term, and then took up part of the time in dwelling upon the ‘utter uselessness of teaching women.’ The professor of surgery went on the staff with great reluctance, and remarked in his introductory lecture that he did not believe in female doctors, and that the students were greatly mistaken if they imagined the world was waiting for them. His lectures chiefly consisted of trifling anecdotes.”[93] The class which graduated in 1871 under these discouraging circumstances consisted of three students. No one would study more than two years, “because it was found that in that time could easily be mastered all the college had to teach.” But in 1881, the graduating class rose to 17, and in 1889, to 24. There is now a Faculty of twenty members, with eight lecturers and assistants. There were 90 students in the current year, and it was announced that in twenty years had been graduated 242 pupils.
In 1863, the same year in which Dr. Thompson settled in Chicago, another graduate of the Philadelphia school penetrated still further west, and tried to establish herself in San Francisco. But this pioneer enterprise failed. In 1872, Mrs. Charlotte Blake Brown applied to be admitted to the medical colleges of San Francisco, but being refused, went to Philadelphia to study. In 1874 Mrs. Lucy Wanzer applied at the Toland Medical School. This had been founded by a generous millionaire, who presented it to the State University,—and as the State laws provide for the admission of both men and women to the State schools, the regents were compelled to receive Mrs. Wanzer, who thus was the first woman to graduate in medicine on the Pacific Coast. In 1875 the rival school, the Cooper Medical College, also opened its doors to women, Mrs. Alice Higgins being the first candidate. Both colleges now freely admit women, and there are about half a dozen in each class.
Three of the ladies at present practicing in San Francisco are, however, graduates of Paris.[94]
Two other medical schools, both in Western New York, have for several years admitted women: the school of the Syracuse University, and the school at Buffalo.
Finally, in 1882, a fourth woman’s school was opened in Baltimore, and has connected with it a hospital, which is not, however, managed by women. The total number of students annually attending the various institutions which have now been enumerated may be approximately tabulated as follows:
Woman’s Medical College of Pennsylvania, report in 1890, 181 students.
Woman’s Medical College, N. Y. Infirmary, report in 1890, 90 students.
Woman’s Medical College, Chicago, report in 1890, 90 students.
University of California, report in 1890, 8 female students out of total of 27.
Cooper College, San Francisco, report in 1890, 18 women out of total of 167.
From Ann Arbor I have only obtained the list of female graduates, which is 88.
The total number of graduates from the Philadelphia School, who have been enrolled among the alumnæ, is 560.
The total number of graduates of the New York School is 135.
During the current year, a movement has been inaugurated to obtain admission for women to the medical school of the Johns Hopkins University for the purpose of advanced study.[95]
Future advance for the education of women in medicine must be in the line of their admission to the schools where the highest standard of education is maintained; and to such affiliation of their own schools with universities, as may bring them under the influence of university discipline. There is no manner of doubt that, with a few unimportant restrictions, co-education in medicine is essential to the real and permanent success of women in medicine. Isolated groups of women cannot maintain the same intellectual standards as are established and maintained by men. The claim of ability to learn, to follow, to apply knowledge, to even do honest original work among the innumerable details of modern science, does not imply a claim to be able to originate, or to maintain by themselves the robust, massive intellectual enterprises, which, in the highest places, are now carried on by masculine strength and energy.