permitted 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

have thus been reënforced 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 altogether 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.* The two monographs cited below are both based upon circulars of questions sent out to as many women physicians as possible. 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. 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.§

"The Practice of Medicine by Women in the United States." Paper read before Social Science Association, by Emily H. Pope, M.D., Sept. 7, 1881; and The College Story,"-address at Woman's Medical College of Philadelphia, by Dean Rachel Bodley, March 17, 1881.

Dr. Bodley sent circulars only to the graduates of the Philadelphia school, of whom, in 1881, there had been 276. Of these, 189 answered the circular. Dr. Pope sent circulars to 470 graduates cf all schools, and received 390 answers, many, however, duplicating those of the Philadelphia circular

of March.

$2907.30 exactly.

The writer knows personally of two women physicians, one in large general practice including much surgery, the other at the head of a Sanitarium, who have each brought up and educated twelve children. One of these ladies was a widow, with one child, when she began to study medicine; the other was never married. A very large number of childless women adopt children, or contribute to the education of the children of brothers or sisters.

So 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." 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. 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

* A distinguished surgeon recently wrote to a woman physician, when he had confirmed her diagnosis in a serious case, where the family then requested the presence of the consultant at the operation the woman physician was to perform : "I shall be out of town for a week; you had better not wait for me-go ahead and operate yourself." Which she did successfully.

The above form of consultation has greatly extended the facilities of medical treatment for unmarried women and young girls.

physician, 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.*

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. 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

*"I believe that the department of medicine in which the great and beneficent influence of women may be especially exerted, is that of the family physician. Not as specialists, but as the trusted guides and wise counselors in all that concerns the physical welfare of the family, they will find their most congenial field of labor. Elizabeth Blackwell, The Influence of Women in the Profession of Medicine." Address before London Medical School for Women, 1889.

66

See Tenon's report on the Hôtel Dieu of Paris, made to the National Assembly in 1789. He describes the usage of the time, which eight centuries of hospital existence had not taught how to improve.

they 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 gynecology have here again offered peculiar advantages, in presenting a series of cases for operation which vary from the most trifling* 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 gynecological 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.f

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. These statistics,

* Dr. Sims, in his treatise on Uterine Surgery, declared that the local treatment of uterine diseases was, almost always, surgical.

During this year Dr. Broomall has gone to Asia, to make a tour of the different missionary stations where there are women physicians, and there perform capital operations on the cases which have been accumulating. This is an expedition unique of its kind in history.

At the meeting of the Philadelphia Alumnæ Association, held in March, 1889, six successful cases of capital operations in abdominal surgery were reported by members, including two Cæsarean sections and one hysterectomy, Sixteen laparotomies were further reported from the Woman's Hospital, but these have been included in the statistical tablę,