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VII.

WOMAN IN MEDICINE.

BY

MARY PUTNAM JACOBI, M.D.

“Fifty years hence, it will be difficult to gain credit for the assertion that American women acquiesced throughout the former half of the 19th century, in the complete monopoly of the medical profession by men, even including midwifery, and the diseases peculiar to women. The current usage in this respect is monstrous.”—New York Tribune, Editorial, 1853.

The history of the movement for introducing women into the full practice of the medical profession is one of the most interesting of modern times. This movement has already achieved much, and far more than is often supposed. Yet the interest lies even less in what has been so far achieved, than in the opposition which has been encountered: in the nature of this opposition; in the pretexts on which it has been sustained, and in the reasonings, more or less disingenuous, by which it has claimed its justification. The history, therefore, is a record not more of fact, than of opinion. And the opinions expressed have often been so grave and solid in appearance, yet proved so frivolous and empty in view of the subsequent event, that their history is not unworthy careful consideration among that of other solemn follies of mankind.

In Europe, the admission of women to the profession of medicine has been widely opposed because of disbelief in their intellectual capacity. * In America it is less often permitted to doubt-out loud—the intellectual capacity of women. The controversy has therefore been shifted to the entirely different ground of decorum.

At the very outset, however, two rival decorums confronted

* See the arguments interchanged in open letters,-learned essays, between Prof. Bischoff attacking, and Prof. Hermann defending, the admission of women to the University of Zurich. See also the address made last year by Prof. Waldeyer, before the Society of German Physicians and Naturalists,

each other. The same centuries of tradition which had, officially, reserved the practice of medicine for men, had assigned to women the exclusive control of the practice of midwifery. It was assumed that midwifery did not require the assistance of medical art,—that the woman in labor traversed a purely physiological crisis, and required only the attendance of kindness, patience, and native sagacity,—all obtainable without scientific knowledge, from her own sex. This being taken for granted, the propriety of limiting such attendance to women appeared so self-evident, that, from the beginning of the world till the eighteenth century A.D, the custom was not seriously questioned. There is an exact parallelism between the relations of men to midwifery and of women to medicine. The limitation of sex in each case was decided by a tradition so immense, as to be mistaken for a divinely implanted instinct, intended by Providence as one of the fundamental safeguards of society and of morals. In each case the invasion by one sex of a “sphere” hitherto monopolized by the other, aroused the coarsest antagonism of offended delicacy. In each case finally, a real basis existed for the traditional etiquette : there was some reason for protesting against the introduction of the male accoucheur into the lying-in room, or of the ardent young girl into the medical school. But in each case, whatever reasons for protest existed, were outnumbered and outweighed by others, to whose greater importance they were finally compelled to give way. Other things being equal, it was unpleasant for a woman to be attended in the crisis of her confinement by a man. But when the necessity for knowledge was recognized, when men became skilled while midwives remained ignorant, the choice was no longer possible; the greater decorum of female midwifery was obliged to yield to the greater safety of enlightened masculine practice. Similarly, it was occasionally unpleasant for young women students to find themselves engaged in certain subjects of medical study together with classes of young men. But in proportion as midwifery became enlarged by the new province of gynæcology, did occasions multiply on which it was extremely unpleasant for non-medical women to be medically treated by men. The difficulties of educating a relatively few women in medicine were compelled to be accepted, in order to avert the far greater difficulties of medical treatment for a very large number of women.

The history of medical women in the United States, to which these pages exclusively apply, may be divided into seven periods, as follows ;

First, the colonial period of exclusively female midwifery, * many of whose practitioners, according to their epitaphs, are reported to have brought into the world one, two, or even three thousand babies apiece. The Mrs. Thomas Whitmore of Marlboro, mentioned in the note, is especially described as being “possessed of a vigorous constitution, and frequently traveling through the woods on snow-shoes from one part of the town to another by night and by day, to relieve the distressed.”f

During this period of female midwifery, the medical profession proper of the colonies reinained entirely unorganized and inarticulate. $ Without making especial inquiry, a superficial observer could have almost overlooked the existence of doctors, as a special class, in the community.

There followed, however, a second period, that, namely, . of the Revolution, and the years immediately preceding and following it. During the former, physicians began to travel to Europe for instruction. During the Revolutionary war their public services in the military hospitals, though apparently not very useful to the sick, $ yet served to bring the profession, for the first time, out of obscurity; and the

*“It is scarcely more than half a century, since among us, females were almost the only accoucheurs.”—“ Remarks on the employment of Females as Practitioners in Midwifery,” by a Physician. Boston, 1820. See also collections Maine Historical Society ; Proceedings General Court held at Wells, July 6, 1646, to“ present ” Frances Rayns for presuming to act the part of midwife. Also, Blake's Annals of the town of Dorchester. Record of death, in 1705, of Mrs. Wiat, aged 94 years, having as midwife assisted at the births of 1100 and odd children. Also Thomson's History of Vermont, sketching the career of Mrs. Thomas Whitmore in town of Marlboro, 1765. In the town records of Rehoboth is mentioned the arrival, on July 3, 1663, of Dr. Sam Fuller and his mother, he to practice medicine,-she as midwife, “to answer to the town's necessity, which was great.” So also Mrs. Elizabeth Phillips settled in Charleston in 1718. Anne Hutchinson began her career as a midwife. It will be remembered that the mother of William Lloyd Garrison practiced midwifery in Baltimore, and thereby supported herself and two children, after she had been mysteriously deserted by her husband.

+ This sturdy woman lived to be eighty-seven years of age ; an ironical comment on the theory of necessarily deficiency of endurance in the female sex.

† “ More than 150 years elapsed after the first settlement, before a single effort was made either by public authority or by the enterprise of individuals, for the education of physicians, or for improving the practice of medicine. .... No medical journal was published in America, until toward the close of the 18th century. .... The first anatomical dissection was made in New York, in 1750.—Thacher, Am. Med. Biog. 1828, p. 16.

$ “It would be shocking to humanity to relate the history of our general hospital in the years 1777 and 1778, when it swallowed up at least one half

opportunities afforded for the collective observation of disease on a large scale, first breathed the spirit of medical science into the American profession. The first achievement of the new-born interest in medical art and education was the expulsion of “females," from even the outlying provinces of the profession, and from their world-old traditional privileges as accoucheurs. * It was a harsh return to make for the services rendered to the infant settlements by these valiant midwives, who had been tramping through the snow by night and by day to bring into a very cold world the citizens of the future republic!t

Third. After this, however, came a period of reaction. In 1848, a Boston gentleman, Mr. Samuel Gregory, began to vehemently protest against the innovation of "male midwives,” and, opened a crusade on behalf of the women, with something of the pathetic ardor of the Emperor Julian for a lost cause. I To judge by the comments of the public press, Mr. Gregory's protest against "man-midwifery” awoke sympathetic echoes in many quarters. At the present day the interest in the movement thus roused, at once progressive and reactionary, lies chiefly in the remarkable similarity between the arguments which were then advanced against the intrusion of men into

our army, ..... by crowding and consequent infection.” ....At Bethlehem, out of 40 men who came sick from one regiment, -not three returned alive. -Tilton on Military Hospitals (quoted by Tower, “Medical Men of the Revolution.” Address 1876, p. 77.)

*“ It was one of the first and happiest fruits of improved medical education in America, that females were excluded from practice; and this has only been effected by the united and persevering efforts of some of the most distinguished individuals of the profession.”—Remarks of a Boston physician, cited ut supra.

+ The suppression of midwives was more immediately due to the development of obstetrical science in England, whither the more ambitious among the colonial physicians were beginning to travel for instruction, and where their intellects were quickened by direct contact with the minds of men of genius. In 1752 Dr. James Lloyd, returning after two years' study in England, began to practice obstetrics in Boston: In 1762, Dr. Shippen, similarly prepared, began to lecture on obstetrics in Philadelphia. (“ Hist. of Art of Midwifery," Lecture by Dr. Augustus Gardner, 1851). These actions sounded the professional death-knell of the poor midwives. Organized knowledge must invariably triumph over unorganized ignorance, even though tradition, decorum, and religion be all on the losing side.

t“Man-midwifery Espoused and Corrected ; or, The Employment of Men to attend Women in Childbirth, shown to be a modern innovation, unnecessary, unnatural, and injurious to the physical welfare of the Community, and pernicious in its influence on Professional and public Morality." By Samuel Gregory, A.M., Lecturer on Physiology. Boston, 1848.

midwifery, and those which were subsequently urged against the admission of women to medicine. Thus:

“The employment of men in mid- “ To attend medical clinics in wifery practice is always grossly in- company with men, women must lay delicate, often immoral, and always aside their modesty. There are still constitutes a serious temptation to enough gentlemen who would blush immorality." – Summary of Mr. to expose their mothers or sisters or Gregory's argument in "Man-Mid wives to what, before women, would wifery Exposed," 1848.

be improper and indecent.”—Letter to editor N.Y. Med. Record, 1884, by

M. K. Blackwood. “I view the present practice of “History, physiology, and the gencalling on men in ordinary births, eral judgment of society unite in the .... as a means of sacrificing deli negative of woman's fitness for the cacy and consequently virtue. medical office.”-Woman and her Thomas Ewell, M.D., of Virginia. Physician.Lecture, Theoph. Par

vin, Prof. Dis. Women, 1870. “The practice (of male midwif. “If I were to plan with malicious ery) is unnecessary, unnatural, and hate the greatest curse I could conwrong, it has an immoral ten ceive for women, if I would estrange dency.”W, Beach, M.D., New them from the protection of women, York.

and make them as far as possible loathsome and disgusting to man, I would favor the so-called reform which proposed to make doctors of them.”Editorial Buffalo Med.

Journal, 1869, p. 191. “ There are many cases of practice “There are free-thinkers in the among women ....in which the medical profession as there are freesense of propriety would decide that lovers in social life. .... The opthe presence of a female practitioner position of medical men arises beis more desirable than that of a cause this movement outrages all man. -New York Observer, 1850. their enlightened estimate of what

a woman should be. It shocks their refined appreciation of woman to see her assume to follow a profession with repulsive details at every step, after the disgusting preliminaries have been passed.” — Sherry, Med.

and Surg. Reporter, July 6, 1867. “There are a few self-evident “It is obvious that we cannot inpropositions which it would be ques struct women as we do men in the tioning the common sense of man science of medicine ; we cannot carry kind to doubt. One is that women them into the dissecting room and are by nature better fitted than men hospital ; many of our more delicate to take care of the sick and the suf feelings, much of our refined sensifering.”—Godey's Lady's Book, 1850. bility must be subdued before we

can study medicine ; in females they must be destroyed ”–Remarks on Employment of Females as Practi

tioners, Boston, 1820. “ The especial propriety of quali. “The ceremonies of graduating fying women to practice among Miss Blackwell at Geneva may well

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