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Looking back over the history of women in medicine

Just over 150 years ago that Elizabeth Blackwell, a determined young student, became the first American woman to gain admission to medical school. Yet her acceptance to Geneva Medical College had been a mere accident. The faculty had not wanted to admit women, but desiring the student body's support, they had put the issues to a vote. Imagine their shock when the class in a joking mood, voted unanimously to accept her. A classmate wrote years later about Blackwell's first day (Smith, 1911):

" A lady, on his invitation, entered, whom he formally introduced as Miss Elizabeth BlackwellA hush fell upon the class as if each member had been stricken with paralysis. A death-like stillness prevailed during the lecture, and only the newly arrived student took notes. She retired with the professor, and thereafter came in with him and sat on the platform during the lecture."

Despite a flurry of protests within the medical community, other pioneer women soon followed suit, notably among them Elizabeth's younger sister, Emily Blackwell, as well as Maria Zakrzewska, Mary Putnam Jacobi, and Ann Preston. The Women's Medical College of Pennsylvania opened in 1850, the first of several institutions devoted primarily to the medical education of women. In 1857, the Blackwell sisters, along with Zakrzewska, founded the New York Infirmary for Women and Children.

By the end of the 19th century, 19 women's medical colleges and 9 women's hospitals had been established. The struggle for coeducation, however, was initially successful only in a minority of institutions, hampered in large part by the theories of Harvard professor Edward H. Clarke (1874) who proclaimed that women seeking advanced education would develop "monstrous brains and puny bodies [and] abnormally weak digestion." As Mary Putnam Jacobi wrote (1891), "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."

This early pioneer generation endured the hard years of study with little support even from their own families and often flagrant discrimination. Sensing that the future of the entire female gender lay upon their shoulders, they worked even more diligently to prove their academic merit.. Many eventually graduated at or near the top of their class. The success of these efforts was reflected most obviously in the impressive standing achieved by women physicians by the end of the 19th century. They constituted 5% of American physicians and numbered over 7,000.

The early 20th century, however, saw a decline in the women's medical movement, largely the result of multiple influences - - medical education reform, closing of all but one of the women's medical colleges, the rise of allied health fields such as nursing, public health and social work, and the changing face of medicine itself, becoming more scientific and less humanistic. Furthermore, society in the 1950's glorified domesticity, placing a women's primary role as that of homemaker. So in 1949, just 100 years after Elizabeth Blackwell, still only 5.5% of entering students were women. It wasn't until after the revival of feminism in the 1960's and the passage of Title IX of the Higher Education Act (preventing federal funded educational institutions from discriminating on the basis of gender) that these numbers began to increase significantly. In 1974, 22.4% of new medical school entrants were women; today, that figure has increased to 45.6%.

By the latter part of the 20th century, overt discrimination had become less apparent, yet subtle inequities continued to persist at all levels within the profession - gender discrimination, sexual harassment, the "glass ceiling" phenomenon, and the lack of maternity support were just some of the barriers still faced by women physicians. Recent data suggest, however, that women are increasing their foothold within American medicine. According to the AMA (2000), women now compose 22.8% of U.S. physicians. Within academic institutions, 28% of full-time faculty are women, although their ranks are skewed toward the instructor or assistant professor levels. But the future does look promising. Women now make up 45.6% of new entrants to U.S. medical schools and are an entering majority in 36 schools.

Looking back over the past 150 years, women have made tremendous advances within the medical profession, overcoming traditional barriers to establish their rightful place within the profession. No longer considered strange or peripheral, they have become a strong, vital force, achieving a level of prominence that was unimaginable in the mid-19th century. And as the rising numbers suggest, there is every reason to believe that they will continue to succeed. As Marie Mergler wrote back in 1896, "No woman studying medicine today will ever know how much it has cost the individuals personally concerned in bringing about these changes; how eagerly they have watched new developments and mourned each defeat and rejoiced with each success. For with them it meant much more than success or failure for the individual, it meant the failure or success of a grand cause."

Eliza Lo Chin, MD Adapted from "Historical Perspective" in This Side of Doctoring: Reflections from Women in Medicine, ed. Eliza Lo Chin. (2002) Thousand Oaks: Sage Publications. Pages 1-9.

References:

American Medical Association, 2000. Physician Characteristics and Distribution in the U.S. Chicago, IL:

American Medical Association. Bickel, J., Clark, V., & Lawson, R. (2000.) Women in U.S. academic medicine statistics 1999-2000. Washington, DC:

Association of American Medical Colleges.. Clarke, E. H. (1873.) Sex in education: A fair chance for girls. Boston:

James R. Osgood. Hewlett, S. A. (1986.) A lesser life: The myth of women's liberation in America. New York:

William Morrow. Jacobi, M. P. (1891.) Women in medicine. In A. N. Meyer (Ed.), Woman's work in America (pp.139-205). New York: Henry Holt .

Luchetti, C. (1998.) Medicine women: The story of early-American women doctors. New York: Crown.

Mergler, M. (1896.) History of competitive examinations. In Woman's Medical School, Northwestern University (Woman's Medical College of Chicago) the Institution and Its Founders; Class Histories 1870-1896. Chicago, IL:

Cutler. Morantz-Sanchez, R. (1985.) Sympathy and science. New York: Oxford University Press.

More, E. S. (1999.) Restoring the balance: Women physicians and the profession of medicine, 1850-1995. Cambridge, MA: Harvard University Press.

Smith, S. (1911.) In memory of Dr. Elizabeth Blackwell and Dr. Emily Blackwell. Academy of Medicine, New York & The Women' Medical Association of New York City. New York: The Knickerbocker Press. p. 8-9

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