Part 20
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 society 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.
From 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 operations 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 School, 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 whom 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 │ 1882 1 Hospital │ „ │ 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.
A 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 obligatory 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]
Previous 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 of 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 profoundly 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 than 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.