Address on the Medical Education of Women

by Elizabeth Blackwell and Emily Blackwell

---

---

Address

on the

Medical Education of Women,

Prepared by

Drs. E. and E. Blackwell,

Read Before a Meeting Held at the

New York Infirmary,

December 19th, 1863.

---

---

 

Address.

---

---

The present meeting has been called to consider the subject of organising a Medical College for Women.

I shall take it for granted, therefore, that those present approve of the study of Medicine by Women—either upon the general ground of widening their occupations—or from the feeling that in special departments of medicine, there would be an obvious advantage in being able to consult women—or that they would be valuable as teachers to diffuse sound hygienic knowledge.

There is one other point, however, on which I should like to touch—it is the question of educating good nurses. It has been frequently said to us, "If you would establish a school for nurses,—or if you would make nursing a prominent part in your medical school, it would appeal more forcibly to the public.

Now, we fully acknowledge the need that exists of a good school for nurses. The Infirmary was chartered as a practical school for nurses as well as students; and it has given similar advantages to nurses, in their department, that it has to students—viz., the opportunity of learning, by taking part in practice. In this way it has trained a succession of nurses, who are now employed in New York.

This is a matter on which we have had a good deal of experience. We were engaged in the effort made by the Woman's Central Relief Association at the beginning of the war, to provide nurses for the first military hospitals. Several of our students also have been engaged in these hospitals. Moreover, we are well informed of the results of Miss Nightingale's efforts, both before and since her labors in the Crimea. The result of our experience has been to strengthen our long-entertained conviction, that there must be women physicians to raise up the class of nurses the public require. It is the doctor who must train the nurse; and we have found that men, with the best intentions, find it very difficult to adapt themselves to their instruction; and moreover, that though feeling strongly the necessity, they do not take the same interest in instructing nurses that they do in teaching students. We feel, therefore, that it would be a much easier and more practicable thing to organize good instruction for nurses, after we have formed a medical school, and have drawn together intelligent women, students and assistants, than to form the school for nurses with the hope that the medical school would follow. In fact, we need the higher class to educate the lower, and without them it seems to us impossible to accomplish the work satisfactorily.

We wish it, therefore, to be distinctly understood that a radical improvement in the character and training of nurses, in private service and in connection with public charities, will be the direct result of a superior class of educated women being engaged in medical service—that is of Women Physicians.

Let us then take up the main question, and that we may realize that the practice of medicine by women is a growing influence, and cannot be overlooked, allow me to state a few facts drawn from personal experience.

In 1845 when I resolved to become a physician, six eminent physicians, in different parts of the country were written to, for advice. They all united in dissuading me, stating, "That it was an utter impossibility for a woman to obtain a medical education; that the idea though good in itself, was eccentric and utopian, utterly impracticable!" It was only by long-continued searching through all the colleges of the country, that one was at last found willing to grant admission. When I entered college in 1847, the ladies of the town pronounced the undertaking crazy, or worse, and declared they would die rather than employ a woman as a physician. In 1852, when establishing myself in New York there was the utmost difficulty in finding a boarding-house where the simple name, as physician could be placed; ladies would not reside in a house so marked, and expressed the utmost astonishment that it should be allowed in a respectable establishment. I presented American and foreign testimonials of medical qualification, to one of the city Dispensaries, asking admission as assistant physician, in the department of diseases of women and children; the request was refused. I asked permission to visit in the female wards of one of the city hospitals; the application was laid on the table, not being considered worthy even of notice. There was a blank wall of social and professional antagonism, facing the woman physician, that formed a situation of singular and painful loneliness, leaving her without support, respect, or professional counsel.

Now these few facts taken from individual experience, are fair illustrations of the general feeling of society, and the attitude of the profession towards women physicians in 1852.

Let us see what facts present themselves to justify the assertion, that this new idea is now firmly rooted:

First,—As to the recognition of the propriety of women studying medicine. Since then ten male medical schools have received women as students, and given them the diploma of Doctor. In three states, female medical schools have been established, holding charters granted by the State legislatures; the diploma conferred by them placing their graduates on exactly the same legal footing, as the ordinary physician; the corporators of these female colleges being respectable bodies of men and women, and in some instances enlisting the sanction, by subscription, of a very large number of influential citizens. From the most accurate data, which we have been able to collect, several hundred women have been graduated as physicians at these schools within the last ten years. At five different times, women have been admitted (as exceptions) to our large New-York hospitals to follow the visits of physicians as students, the medical faculties having given their consent in these cases. One of the largest dispensaries in the city, has during the last six years, allowed a little group of respectable female students to continue their daily attendance. The school of Pharmacy has also opened its doors to women as students. No respectable woman practitioner has now any difficulty in holding medical consultation with some of the men most skilled in the various departments of medicine.

These facts will show the growth of professional sentiment, let us see if social feeling has grown in corresponding measure.

Besides the organization of the colleges just alluded to, societies have been formed at different times, for assisting women in the study of medicine; for educating female missionaries in medicine; for popular instruction to women in physiology and hygiene, &c.—these have all come into existence within the last ten years.

I have stated that several hundred women have graduated as physicians within this period; we have traced the history of so many of these physicians, that we think we may truly say, that the majority of them are engaged in active professional life. Some are assistant physicians in the various water-cure and other private establishments, scattered so plentifully through the country; some are employed in large girls' schools, as teachers of physiology, and physicians to the young ladies; some travel from place to place as lecturers on physiological and medical subjects to women, supporting themselves, year after year, in this way; still more are practising as physicians, either alone or in partnership with father or husband. In every part of the Northern and Western States we know of such physicians, who are supporting themselves, and sometimes their families—whose pecuniary receipts vary from a simple living to a handsome income.

Now all will agree that pecuniary success is a very convincing thing! We may deplore the low state of society, which will measure truth by dollars; but nevertheless we cannot shut our eyes to the fact, that the mass of mankind do judge by a low standard. To say, such and such a woman is making $2000 a year by the practice of medicine, creates more respect for the work in the minds of most people, than any amount of argument, or abstract statement of the truth and value of the idea, would do. We can use then this poor, powerful argument of the dollar. We can point out women in Boston, New York, Philadelphia, Cleaveland, and elsewhere, personally known to us who are making more than $1000 or $2000 a year, in a steadily increasing practice; all grown up within ten years!

Several things are proved by this fact. It shows that women can practise medicine in some fashion—they have the head to do it;—that there is nothing in the work itself, to hinder them from doing so—they have the health to do it—; it shows that women will employ them; that imperfect as their education is (as we shall presently see), and with the distinct knowledge on the part of women, that these physicians have not the advantages of education which men enjoy, they nevertheless employ them widely and increasingly.

I think these facts will be considered as establishing the statement that the practice of medicine by women, is no longer a doubtful, but a settled thing; that a new social power is growing up in our midst, concerning which the question is—not shall it exist, but how shall it exist—shall its influence be for good or for harm? It needs but a moment's consideration to see how very deplorable the influence of an ignorant class of female physicians must be!

This brings us to the point to which we wish to call especial attention; the method, viz., by which a thoroughly reliable class of women physicians may be secured.

We will commence the subject by one simple statement—there is not in the whole extent of our country, a single medical school where women can obtain a good medical education. I trust that no one will construe this statement into an attack upon the schools already organized. We have watched their growth with deep interest; we have been solicited to take part in most of them, and would gladly have done so, could we have conscientiously approved of them; but we are very much in earnest in this matter, and dare not waste whatever influence God has given us; and we think that when we have shown what women really require for a medical education, that all will agree with us that a school is needed, which shall be formed on a different plan, organized on a much broader basis.

Consider how women stand in this matter; how alone, how unsupported; no libraries, museums, hospitals, dispensaries, clinics; no endowments, scholarships, professorships, prizes, to stimulate and reward study; no time-honored institutions and customs, no recognized position; no societies, meetings, and professional companionship; all these things men have, none of them are open to women. One can hardly conceive a more complete isolation.

These are external hindrances; there are still more intimate sources of difficulty. Women have no business habits; their education is desultory in its character; girls are seldom drilled thoroughly in any thing; they are not trained to use their minds any more than their muscles; they seldom apply themselves with a will and a grip to master any subject. It may be said that their domestic duties, nursing younger children, helping their mother in the family, will help them to sympathize with and understand family needs as physicians; this is true, I grant fully the value of such knowledge, and yet it must ever be borne in mind, that medicine is a science as well as an art; it needs knowledge as well as feeling. Let us give all due weight to sympathy, and never dispense with it in the true physician; but it is knowledge, not sympathy which can administer the right medicine; it is observation and comprehension, not sympathy, which will discover the kind of disease; and though warm sympathetic natures, with knowledge, would make the best of all physicians, without sound scientific knowledge, they would be most unreliable and dangerous guides. This want of mental discipline is then a very serious difficulty which women have to contend with in any scientific study, and is an evident and potent reason whey they need, not less, but much more careful training than men, in any such study.

The second difficulty under which women specially labor, is poverty. As a general rule, women are poorer than men, and in addition to this fact of greater relative poverty, it will for a long time, be a relatively poorer class, of women than men who will study medicine. It is the young man of some means, who is apt to enter upon the expensive study of medicine, whose father is able to assist him during the years which must necessarily elapse, before he gains a remunerative practice; but experience has already shown, that they are the young women without means, who endeavour to become physicians. They come from a class notoriously poor, viz teachers; out of nineteen young ladies who have resided in the N. Y. Infirmary as students of medicine, eighteen had been teachers. We have found these students eager to learn; glad to spend any amount of time that might be required to qualify themselves for their new duties; their patient perseverance was admirable—but they had no money—the little fund they had scraped together by saving or borrowing was soon spent and they were compelled to hurry into the practice of medicine, imperfectly prepared, from the impossibility of meeting the expense of longer studies.

I think it will be felt by any one, however little acquainted with medical matters, that for women students, laboring under these numerous disadvantages of position and mental discipline, excluded from existing institutions, unprepared for scientific study, with no pecuniary resources—a medical education complying with the barest terms of legal requisition, and modelled after the very lowest type of male medical education, is entirely insufficient. Yet this is all that is now offered to women. Two short courses of lectures from second rate professors; a little practical anatomy which may or may not be followed; the exhibition of a few cases of sickness, a short and slight examination of acquired knowledge, this is all that is provided. The student receives the honorable and responsible title of "Doctor of Medicine," without having had charge of a single sick person, or attended a single case of midwifery, without even being aware of the immense difference between reading of disease in a book, and detecting and dealing with it under its infinite disguises in the sick room.

Without referring to the important subject of the preliminary education which should be required, there are four points in which a medical college for women should differ from any institution now established for them.

First.—The character of examinations for, and manner of conferring the degree of Doctor of Medicine. 2.—The method of education. 3.—The relation to the Profession. 4.—The necessary foundation for a college.

First then, a change is needed in the character of the examinations, and the manner of conferring the degree which is the seal or stamp of the whole education. The object of examination is to ascertain that the individual presenting herself really possesses the knowledge and capacity necessary for assuming the medical charge of the sick, and the directorship of the health of families. This examination should not be a pretence.

The tests now laid down for women medical students are altogether insufficient. To question twenty pupils, or even one pupil during half an hour or an hour on the substance of a hundred lectures, will very imperfectly ascertain even the theoretical knowledge of the pupil on the one special branch, much less will it show her ability to detect disease and control a sick room. Each pupil should be carefully examined not only in all essential theoretical points in the lecture-room or professor's study, but in the still more vital subjects that can only be tested in the hospital by the sick bed, in the surgical and anatomical rooms, by manipulation and demonstrations, and in the laboratory by familiarity with medicines. Examinations in diagnosis, in the practical applications of every branch of medicine, are essential to judge of the qualifications of a physician. This plan of examinations differs in kind as well as degree, from the system now adopted for women. Of course it is much more troublesome, requires a much larger expenditure of time and thought, but we believe that too much labour cannot be expended on examinations, that they are of the very highest importance in securing a class of reliable women physicians.

Secondly,—The plan of education should be enlarged. This will be evident from the character of the examinations which I have sketched; a student formed by the simple plan of lecturing, could not pass through such examinations. In educating medical students we have to deal with young and comparatively undisciplined minds. An experienced medical teacher (Mr. Paget, of London,) once told me that he considered the age of nineteen as the very best for a medical student to begin his studies. Now the mind at this age, and all undisciplined minds of any age, do not work alone to advantage. There is a natural tendency to acquire information vaguely and imperfectly they need to be stimulated, directed, called to account; they need to be shown how to study. General instruction en masse is insufficient, individual instruction is needed; and sub-division into small classes for individual drill should be an essential part of college arrangement for women. The student should be constantly called upon to communicate as well as receive knowledge. The knowledge is not her own until she has used it; and the habit of constantly giving account of what is gained is invaluable in acquiring clearness and precision of thought. In the same way the student must be taught to apply the knowledge gained in the lecture-room, and from books, to the practical duties of the physician. She must be taught how to practice medicine; and the care of the sick under supervision should be an essential part of the future physician's training. (Of course I include in the term medicine, the prevention of disease; the knowledge and application of hygienic law is essential to the education of a woman physician.) This then is the second important change needed in our college system for women; individual discipline, and instruction in practical medicine.

The third point to be spoken of is the attitude assumed towards the Profession. Courtesy and kindly feeling are due to the old and time-honored profession, by those new comers who are still walking with the uncertain steps of inexperience.

It must not be taken for granted that the exclusion of female students from medical colleges and public institutions indicates a settled hostility to the movement. There are many difficulties to be met, in opening to all, facilities which were established with reference to men only, and it should be one great end of special Institutions for women to assist in meeting such difficulties, and forming links with the profession.

Whoever has had experience in this matter will recognise an under current of liberal and generous feeling in the profession, which acknowledges the claim that women have upon their assistance, in any attempt they make to secure for themselves a solid education. Let us then do all we can to deserve confidence, and welcome the interest which is growing in the profession, as they begin to perceive the important character of this work.

Fourthly.—A woman's medical college must be founded on an endowment. Any attempt to commence such a college without means, relying on the fees of students, the self-denial of the teachers, and accidental subscriptions, must result in a very inferior system of instruction.

In undertaking to found a medical college for women, we do not stand in the same position as an ordinary college. The class must necessarily be smaller and poorer. We have not the great incidental assistance which all male colleges have, from the fact that public hospitals and dispensaries are freely at their command. They have the whole influence of the profession to aid them; while the position of a professor or teacher is so much desired, that pecuniary compensation is the least of the advantages connected with it. All this great system of instruction which has gradually been formed for the use of male students is not at present available for women. It is obvious that special arrangements must be made, in order to provide the thorough instruction contemplated for students placed at so great a disadvantage.

This, then, is the last distinctive feature of a good college for women; and these four points, viz., thorough examinations, complete education, friendly relations with the profession, and a substantial foundation, are the improvements which women need, and which the public has a right to demand.

We believe that the time has come to form a really good school of medicine for women. The hospital organization, under the title of the N. Y. Infirmary for Women and Children, has been preparing the way for such a school for nearly ten years, and its working has been watched by the profession even more than by the community during that time. Many of the best men of the medical profession in New York are now prepared to encourage the formation of a medical school for women, in connexion with it. The Trustees of the Infirmary entered into negotiations this spring with the leading medical colleges of New York, to obtain their counsel in this matter. The subject was carefully considered by them; and the result was an expression of friendly interest in the object, with a recommendation to pursue our present plan of action.

We have thus two important elements to start with: an institution of several years' standing, whose directors, whose aims, whose manner of working are already known and approved of; and the friendly confidence of an influential portion of the profession.

Two other things are now wanted, in order to establish a college: money, which men so liberally give; social influence, which women can so effectually exert.

We need such an endowment as will enable us to secure the assistance of first-rate professors, and to commence such a system of education as I have described—thorough, and practical in its character.

It is also necessary that such a body of ladies as well as gentlemen shall join with the Trustees of the Infirmary, as corporators of the College, as will assure the public and the profession, that this effort possesses the sympathy and support of the women of New York.

In appealing to our fellow-citizens for support, or in asking the profession for their aid, it is justly a first consideration with them—is this effort endorsed by the women of our city!

The question has been asked us repeatedly by business men and by physicians.—Can you show that women want this thing done? We know that this question can be answered in the affirmative; we know that there is a wide-spread interest felt by women in this work, and we earnestly appeal to them to prove the truth of this statement by taking part in this effort.

In conclusion we ask all who feel that this is a good work that ought to be accomplished, to realize that it rests with them to assure its success, by an open and decided support.

New York Infirmary

for

Women and Children,

126 Second Avenue.

---

This Institution was incorporated in 1854. Its objects are to aid the sick poor; to give to female students an opportunity of taking part in practical medicine; and to train nurses for the sick. During the past seven years it has relieved 26, 000 patients.

Trustees:
Chas. Butler, President.	Marcus Spring.
Stacy B. Collins, Vice-President.	Cyrus W. Field.
Robert Haydock, Treasurer.	Chas. A. Dana.
Merritt Trimble, Secretary.	Mrs. Henry Baylis.
Samuel Willets.	" Robt. Campbell.
Chas. B. Tatham.	" Peter Townsend.
Richd. H. Bowne.	" Jas B. Wright.
Simeon Draper.	" W. H. Hussey.
Henry J. Raymond.	" E. Blackwell.
Consulting Physicians:
Valentine Mott, M. D. S. L. D.
Willard Parker, M. D.	Jas R. Wood, M. D.
Gustavus A. Sabine, M. D.	Austin Flint, M. D.
Attending Physicians:
Elizabeth Blackwell, M. D.	Emily Blackwell, M. D.
Assistant Physician:
Frances A. Cook, M. D.