You’ve come a long way baby….

1. You’ve come a long way baby…. The History of Women in Medicine Amy Jost, class of 2004

2. Overview of the Talk • Women pioneers and their stories – from the middle ages to present day • Changing Perspectives in recent decades • The Current Situation – where do we go from here?

3. Women in Medicine…earlier than you might have guessed!! • Merit Ptah • Physician (c. 2700 BCE) • Image painted in Egyptian tomb in the Valley of the Kings • Believed to be the world’s first named physician • First woman known by name in history of science • Described by her son, a high priest, as “the chief physician”

4. In the dark ages…. • Best known female healer of the time was the mystic Hildegarde of Bingen (1098-1179) • She wrote two medical manuscripts on plant, animal, and mineral medicines • Her remedies were partly herbal and partly spiritual and/or magical

5. The Middle Ages • During Middle Ages, religious orders took care of sick and poor • 1830: Sisters of Mercy order established in Dublin, known throughout world for care to sick and elderly • 1800s: famous prison reformer Elizabeth Fry set up the Institute of Nursing Sisters

6. The emergence of Nursing • Nurses prior to late 1800s: • Did not require any training • Were badly paid • Didn’t have a respectable reputation • …Enter Florence Nightingale • In 1860 set up the first nurses training school at St. Thomas’s hospital • Devoted life to improving hospital sanitation and establishing the profession of nursing

7. More on Florence Nightingale… • Born 1820, Died 1910 • Devoted life to reform of British military health-care system • Accomplished Mathematician • First person in English speaking world to apply statistics to study of public health • Invented the pie chart • Prolific letter writer

8. Florence Nightingale in the Military Hospital at Scutari Florence was recruited to serve in Scutari during the Crimean War. Here, she collected data on mortality rates and systematized record-keeping practices.

9. Florence Nightingale’s “Polar Area Diagram” Designed to dramatize the needless deaths caused by unsanitary conditions

10. Florence Nightingale sound byte http://www.internurse.com/history/nightingale/flo1.wav what she says is: "At Florence Nightingale's house, London. July the 30th. Eighteen hundred and ninety. When I am no longer even a memory, just a name, I hope my voice may perpetuate the great work of my life. God bless my dear old Comrades at Balaclava and bring them safe to shore."

11. …But what about women doctors?!? “A strange Story” Excerpt from "The Manchester Guardian" in 1865: “An incident is just now being discussed in military circles so extraordinary that, were not the truth capable of being vouched for by official authority, the narration would certainly be deemed incredible. Our officers quartered at the Cape between 15 and 20 years ago may remember a certain Dr Barry attached to the medical staff there, and enjoying a reputation for considerable skill in his profession, especially for firmness, decision and rapidity in difficult operations… upon his death was discovered to be a woman. The motives that occasioned and the time when commenced this singular deception are both shrouded in mystery. “But thus it stands as an indisputable fact, that a woman was for 40 years an officer in the British service, and fought one duel and had sought many more, had pursued a legitimate medical education, and received a regular diploma, and had acquired almost a celebrity for skill as a surgical operator.“

12. The “Beardless Lad”Dr. James Barry - 1795-1865 • Attended Edinburg Medical School • During the Napoleonic Wars was an Army Surgeon • Performed one of the first successful C/Ss • At burial was found to be a woman!!!

13. Elizabeth Blackwell – “That girl there is doctor in medicine!!!” • America’s first woman M.D. • Received diploma January 23, 1849 • Her accomplishment was the result of years of determined effort Elizabeth Blackwell, aged 38

14. The Story of Elizabeth Blackwell • Born in England in 1821 • Moved to America as a child, father died soon thereafter • Found housework unpleasant and uninspiring; wanted an occupation that would satisfy her intellect and idealism • A dying friend confided to her that her suffering would have been more bearable had she been attended by a woman physician • Elizabeth is now determined to become a physician!

15. Discouragement on the road to becoming a doctor • To earn money to support studies, Elizabeth turned to teaching and arranged to live in a physician’s household. • Studied medicine for the year she lived here • However, she failed to gain acceptance to any established medical schools Home of Samuel Dickson, M.D. • Physicians were uniformly discouraging: “Elizabeth, it is of no use trying. Thee cannot gain admission to these schools. Thee must go to Paris and don masculine attire to gain the necessary knowledge.” (Dr. Joseph Warrington, known to be a liberal-minded physician of the time)

16. The acceptance letter finally arrives! • Finally, Elizabeth received a single acceptance from Geneva Medical College in Geneva, N.Y. • Faculty initially opposed her admission but felt they were unable to turn down such a qualified candidate • As a result, they referred the decision to the students… – they thought it was a joke – and voted to unanimously admit her! • A few weeks later to their surprise, the “lady student” arrived in the lecture room Elizabeth Blackwell’s letter of admission

17. First day of med school… “A lady, on his invitation, entered, whom he formally introduced as Miss Elizabeth Blackwell…A 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.” (classmate’s memory of Blackwell’s first day)

18. Life at Geneva Medical College • The novelty of Elizabeth’s gender made her first days of med school very difficult • Curious strangers would wander into lectures to stare at her Geneva Medical College – one of many small, short-lived medical schools that flourished in 19th century America.

19. Shunned by the townspeople “I had not the slightest idea of the commotion created by my appearance as a medical student in the little town. Very slowly I perceived that a doctor’s wife at the table avoided any communication with me, and that as I walked backwards and forwards to college the ladies stopped to stare at me, as at a curious animal. I afterwards found that I had so shocked Geneva propriety that the theory was fully established either that I was a bad woman, whose designs would gradually become evident, or that, being insane, an outbreak of insanity would soon be apparent.”

20. Anatomy Dissection – always a delicate subject • Elizabeth’s attendance at anatomy lectures produced embarrassment • Her professor suggested that she stay away on the days reproductive anatomy was demonstrated • She stated she wished simply to be treated as another student • "November 22.--A trying day, and I feel almost worn out, though it was encouraging too, and in some measure a triumph; but 'tis a terrible ordeal! That dissection was just as much as I could bear. Some of the students blushed, some were hysterical, not one could keep in a smile ... My delicacy was certainly shocked, and yet the exhibition was in some sense ludicrous. I had to pinch my hand till the blood nearly came ... Dr. Webster, who had perhaps the most trying position, behaved admirably." (Diary, Nov. 22, 1847)

21. Graduation at long last • In his graduation address, the Dean declared his wholehearted admiration for the first female M.D. • However, in the printed version of the address, he added the following footnote stating that, though he supported medical education for qualified women, the “inconveniences attending the admission of females to all the lectures in a medical school are so great that he will feel compelled on all future occasions to oppose such a practice…” Elizabeth’s diploma

22. Life after medical school isn’t always easy… • Despite her degree, Elizabeth could not secure a position for internship • The only opportunity she could find at a lying-in hospital in Paris required that she not be called “doctor” • She eventually returned to the United states where she was unable to establish a successful medical practice • Elizabeth devotes the rest of her life to the promotion of hygiene and preventive medicine and the promotion of opportunities for women physicians La maternite de Paris

23. Other women follow suit… • Despite protests from the medical community, many women followed Elizabeth’s lead • Women’s Medical College of Pennsylvania opened in 1850 – the first of several institutions devoted primarily to medical education of women Women’s Medical College of Pennsylvania

24. Creating opportunities for future women physicians • In 1857 Elizabeth opened the New York Infirmary for Indigent Women and Children – served poor and provided opportunities for women physicians • This institution still exists as the New York University Downtown Hospital • She eventually opened the Women’s Medical College of the New York infirmary in 1868 Anatomy lecture room at the Women’s Medical College of New York Infirmary

25. Struggle for co-education… • By the end of the 1800s, 19 women’s medical colleges and 9 women’s hospitals had been established. • Harvard professor Edward H. Clarke (1874) proclaimed theories that women seeking advanced education would develop “monstrous brains and puny bodies…[and] abnormally weak digestion.” Elizabeth B. Scott (1866-1958), Student at the Woman's Medical College, Kingston, ca. 1888

26. The early pioneer generation • Led by determined women including Elizabeth Blackwell and her sister, Mary Putnam Jacobi, Ann Preston, Maria Zakrzewska • “It is perfectly evident from the records, that an opposition to women physicians has rarely been based on 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.” –Mary Putnam Jacobi, 1891 Mary Putnam Jacobi and her peers

27. The early pioneer generation, contd. • These women endured hard years of study with little support • Many graduated at or near the top of their class • By the end of the 19th century, women physicians constituted 5% of American physicians and numbered over 7,000 “There’s a woman doctor in the house” –cover of German gazette, late 1800s

28. Moving on into the 20th century • Early 1900s saw a decline in the women’s medical movement due to: • Medical education reform • Closing of all but one of the women’s medical colleges • Rise of allied health fields such as nursing, public health and social work • Changing face of medicine: more scientific, less humanistic State Hospital of Missouri Nurses, 1914

29. Society in the 1950’s • In the 1950’s there was a glorification of domesticity – a woman’s primary role was that of a homemaker • In 1949 (100 years after Elizabeth Blackwell!!), still only 5.5% of entering students were women!

30. Enter into the 1960’s… • This era saw a revitalization of feminism • Passage of Title IX of the Higher Education Act prevented federal funded educational institutions from discriminating on the basis of gender • Numbers began to increase significantly – in 1974, 22.4% of new medical school entrants were women

31. Women in medicine – recent decades • A rise in women applying to medical school began in the 1970’s due to • Increase in medical schools and slots • The “Women’s Movement” • The Equal Opportunity Act was passed • Growing number of “baby boomer girls” were finishing college

32. At the end of the 20th century… • Overt discrimination less apparent • However subtle inequities persisted at all levels • Gender discrimination • Sexual harassment • The “glass ceiling” phenomenon • Lack of maternity support

33. Where are we now?? • According to the AMA, women now compose 22.8% of U.S. physicians • 28% of full time faculty are women • Women make up 45.6% of new entrants to medical schools

34. Still room for improvement… • Of the country’s male physicians, 59.9% are self-employed, compared to 39.3% of female physicians. • 56.2% of female physicians are employees compared to 35.4% of male physicians • Women represent only 27.6% of all medical school faculty • Of the 119 medical college deans, only six deans are female

35. Academic Medicine • Women join academic ranks post graduation at higher rates than men • However they advance to senior ranks less and leave academic ranks at higher rates • In 1998, 82.6% of women physicians were involved in patient care; only 2.9% in administration or research • Perceived reasons why- micro-inequities • less mentoring, publish less, less support and resource • lack of visibility and isolation, failure of support more attractive alternatives

36. Medical School Graduates 16 14 12 10 Women 8 All 6 4 2 0 1960 1970 1980 1990

37. U.S. Physicians 1970-2001

38. Percent Distribution of Total US Physicians by Age and Sex, 2001

41. Women in AcademicsNEJM - 2/00 - Associate Profs 100% 90% 80% 70% 60% Men 50% Women 40% 30% 20% 10% 0% Surgery ObGyn Radiology Anesthesia Peds

42. What about the University of Chicago??? Source: American Association of Medical Colleges (AAMC) Statistics 2001-2002

43. Conclusions • Over the past 150 years, women have made tremendous advances within the medical profession • In recent years, significant progress has been made in efforts to close the gender gap • Needless to say, the future is bright for women in medicine!

44. References • More, Ellen S. Restoring the Balance: Women Physicians and the Profession of Medicine, 1850-1995. Harvard University Press, 1999. • Wear, Delese, editor. Women in Medical Education: An Anthology of Experience. State University of New York Press, 1996. • Campbelll, Margaret A. (a pseudonym). Why Would a Girl Go Into Medicine? Medical Education in the United States: A Guide for Women. The Feminist Press, New York, 1973. • Women in U.S. Academic Medicine: Statistics 2001-2002. Prepared by Association of American Medical Colleges. • http://www.nlm.nih.gov/hmd/blackwell