Women's Studies Program
	Le Moyne College, Syracuse, New York
	Elizabeth and Emily Blackwell: Medicine as a Profession for Women

Elizabeth and Emily Blackwell: Medicine as a Profession for Women

The idea of the education of women in medicine is not now an entirely new one; for some years it has been discusses by the public, institutions have been founded professing to accomplish it, and many women are already engaged in some form of medical occupation. Yet the true position of women in medicine, the real need which lies at the bottom of this movement, and the means necessary to secure its practical usefulness and success, are little known. We believe it is now time to bring this subject forward and place it in its true light, as a matter not affecting a few individuals only, but of serious importance to the community at large and demanding such support as will allow of the establishment of an institution for the thorough education of women in medicine.

When the idea of the practice of women is suggested, the grounds on which we usually find sympathy expressed for it are two. The first is, that there are certain departments of medicine in which the aid of women physicians would be especially valuable to women. The second argument is, that women are much in need of a wider field of occupation, and if they could successfully practice any branch of medicine it would be another opening added to the few they already possess. In some shape or other, these two points are almost universally regarded (where the matter has been considered at all) as the great reasons to be urged in its behalf.

Now, we believe that both these reasons are valid, and that experience will fully confirm them; but we believe also that there is a much deeper view of the question than this; and that the thorough education of a class of women in medicine will exert an important influence upon the life and interests of women in general, an influence of a much more extended nature than is expressed in the above views... .

. .The interests and occupations of women, as they actually are at present, may be referred to four distinct forms of efforts: - Domestic life; the education of youth; social intercourse, and benevolent effort of various kinds. All these avocations, by unanimous consent, are especially under the superintendence of women, and every woman, as she takes her place in society, assumes the responsibility of participation in some of them.

While these pursuits have always formed the central interest of the majority of women, their character, and the requirements which they make for their proper performance, have widened, with the advance of modern society, in a remarkable degree. Social intercourse - a very limited thing in a half civilized county, becomes in our centres of civilization a great power, establishing customs more binding than laws imposing habits and stamping opinions, a tribunal from, whose judgment there is hardly an appeal. All who are familiar with European life, and the life of our great cities, know what an organized and powerful force it ever tends to become.

In like manner, benevolent efforts have little influence in new countries, but in Europe, especially in England, the extent of such work, and the amount of it which is done by women would be incredible, did we not see here, in our midst, the commencement of a similar state of things.

Domestic life is not less affected by the growth of the age; the position and duties of the mother of a family call for very different qualifications, in the wide and complicated relations of the present, from what was needed a century ago.

Now it is evident that the performance of all these forms of work, extended and organized as they are, is in its practical nature a business requiring distant knowledge and previous preparation, as much as actual trades and professions. This fact would be more commonly recognized were it not that there is so much moral and spiritual life interwoven into woman’s work by the relations upon which it is founded, and out of which it grows, as to make it more difficult to separate this business aspect of her work from her personal life, that is the case with the business life of men; consequently its practical character is too often considered entirely subordinate, or lost sight of. Every woman, however, who brings thought and conscience to the performance of everyday duties, soon realizes it in her own experience. The wider the view she takes of life, the higher her ideal of her domestic and social relations, the more keenly she will feel the need of knowledge with regard to this matter of fact basis upon which they rest. The first and most important point in which she will feel the want of this previous training will be in her ignorance of physiological and sanitary science, in their application to practical life; of the laws of health and physical and mental development; of the connection between moral and physical conditions, and the influences which our social and domestic life exert upon us. These and similar questions will meet her at every step, from the commencement of her maternal life, when the care of young children and of her own health bring to her a thousand subjects of perplexity, to the close of her career, when her children, assuming their positions as men and women, look to her as their natural counselor.

It may be said, at first sight, that in these things it is not so much knowledge as common sense and earnestness that is wanted; that as health is the natural condition, it will be secured by simply using our judgment in not positively disregarding what our natural instincts teach us in regard to our lives. This would be true if civilization were a simple state directed by instinct; but every advance in social progress removes us more and more from the guidance of instinct, obliging us to depend upon reason for the assurance that our habits are really agreeable to the laws of health, and compelling us to guard against the sacrifice of our physical or moral nature while pursing the ends of civilization. . . .

In education, as in domestic life, the same necessity for hygienic knowledge exists. Statistics show that nine-tenths of our teachers are women, and it is obviously a matter of great importance that they should be familiar with the nature the needs of the great body of youth which is intrusted to their care. It is not possible that our systems of education should be really suited to childhood, training its faculties without cramping or unduly stimulating the nature, unless those by whom this work is done understand the principles of health and growth upon which school training should be based. Our school education ignores, in a thousand ways, the rules of health development; and the results, obtained with much labor and expense, are gained very generally at the cost of physical and mental health.

If, then, it be true that health has its science as well as disease; that there are conditions essential for securing it, and that every-day life should be based upon its laws; if, moreover, women, by their social position, are important agents in this practical work, the question naturally arises, how is this knowledge to be widely diffused among them? At present there exists no method of supplying this need. Physiology and all branches of science bearing upon the physical life of man are pursued almost exclusively by physicians, and from these branches of learning the deduce more or less clear ideas with regard to the conditions of health in every-day life. But it is only the most enlightened physicians who do this work for themselves; a very large proporting of the profession, who are well aquatinted with the bearing of this learning upon disease, would find it a difficult matter to show its relation to the prevention of disease, and the securing of health, by its application to daily life. If this be the case with regard to physicians, it must evidently be impossible to give to physicians, it must evidently be impossible to give to the majority of women the wide scientific training that would enable them from their own knowledge to deduce practical rules of guidance. This must be done by those whose avocations require wide scientific knowledge by physicians. Yet the medical profession is at present too far removed from the life of women; they regard these subjects from such a different stand- point that they can not supply the want. The application scientific knowledge to women’s necessities in actual life can only be done by women who possess at once the scientific learning of the physician, and as women a thorough acquaintance with women’s requirements - that is, by women physicians.

That this connecting link between the science of the medical profession and the every-day life of women is needed, is proved by the fact that during the years that scientific knowledge has been accumulating in the hands of physicians, while it has revolutionized the science of medicine, it has had so little direct effect upon domestic life. Twenty years ago, as now, their opinion was strongly expressed with regard to the defects in the adaptation of modern life and education to the physical well being of society, and particularly of its injurious results to women. Yet, as far as these latter are concerned, no change has been effected. In all such points women are far more influenced by the opinions of society at large, and of their elder women friends, than by their physician, and this arises from the fact that physicians are too far removed from women’s life; they can criticize but not guide it. On the other hand, it is curious to observe that, as within the last few years the attention of a considerable number of women has been turned to medicine, the first use they have made of it has been to establish a class of lectures on physiology and hygiene for women. They are scattered all over the country; the lectures are generally as crude and unsatisfactory as the medical education out of which they have sprung; but the impulse is worthy of note, as showing the instinctive perception of women, as soon as they acquire even a slight acquaintance with these subjects, how directly they bear upon the interest of women, and the inclination which exists to attempt, at least, to apply them to their needs. As teachers, then, to diffuse among women the physiological and sanitary knowledge which they need, we find the first work for women physicians.

The next point of interest to be noticed is the connection of women with public charities and benevolent institutions.

In all civilized nations women have always taken an active share in these charities; indeed, if we include those employed in the subordinate duties of nurses, matrons, etc., the number of women actually engaged would much outnumber that of men. How large a part of the character of these institutions, and of the influence exerted by them upon society, is dependent upon this great body of women employed in them and connected with them, may readily be imagined. Yet it is certain, and admitted by all who have any acquaintance with the matte, that this influence at present is far from a good one. It is well known how much the efficiency of women as managers or supporters of public institutions is impaired by the lack of knowledge and practical tact to second their zeal; and business men who have dealings with them in these relations are very apt to regard them as trouble-some and uncertain allies, rather than as efficient co-workers...

... In England, where all public institutions, hospitals - civil and military -workhouses, houses for reformation, prisons, penitentiaries, etc., form a great system, dealing with the poorer classes to an immense extent, and having a social importance too serious to be overlooked, the question has assumed sufficient weight to be discussed earnestly by government and the public at large.

In Catholic countries this is accomplished to a certain extent - that is, as far as the domestic and nursing departments are concerned - by the religious orders, the sisters of charity and others. . .

It is very common among Catholics and Protestants to consider these sisterhoods as the result entirely of religious enthusiasm, and to assert that large bodies of women can only be induced to accept these occupations, and carry them out in this efficient manner from this motive. When efforts have been made in England and Germany to establish any thing of the kind among Protestants, it is always to the religious element that the appeal has been made...In England, the results have been very imperfect, and have entirely failed to secure any thing approaching in practical efficiency to the Catholic sisterhoods.

Now these failures are very easily comprehended by any one who has seen much of these sisters in actual work, for such persons will soon perceive that he practical success of these orders does not depend upon religious enthusiasm, but upon an excellent business organization. Religious feeling there is among them, and it is an important aid in filling their ranks and keeping up their interest; but the real secret of their success is in the excellent opening afforded by them for all classes of women to a useful and respected social life. The inferior sisters are plain, decent women, nothing more, to whom the opportunity of earning a support, the companionship, protection and interest afforded by being members of a respected order, and the prospect of a certain provision for age, are the more powerful ties to the work, from the fact that they are generally without means, or very near connexions, and would find it difficult to obtain a better or so good a living. The superior sisters are usually women of character and education, who, from want of family ties, misfortune, or need of occupation, find themselves lonely or unhappy in ordinary life; and to them the church, with its usual sagacity in availing itself of all talents, opens the attractive prospect of active occupation, personal standing and authority, social respect, and the companionship of intelligent co-workers, both men and women - the feeling of belonging to the world, in fact, instead of a crippled and isolated life. For though it is common to speak of the sisters as renouncing the world, the fact is, that the members o f theses sisterhoods have a far more active participation in the interests of life than most of them had before. No one can fully realize the effect this has upon them, unless they have at once seen them at their work, and are aware how welcome to great numbers of women would be an active, useful life, free from pecuniary cares, offering sympathy and companionship in work and social standing to all its members, with scope for all talents, from the poorest drudge to the intelligent and educated woman - an offer so welcome as to be quite sufficient to overcome the want of attraction in the work itself at first sight.

As we have said, every effort so far to introduce a corresponding class of women into English institutions has proved a failure, for there is no such organization in external life in Protestant churches as there is in the Catholic. . .

The only way to meet the difficulty, to give a centre to women who are interested in such efforts, and to connect intelligent women with these institutions, is to introduce women into them as physicians. If all public charities were open to well educated women physicians, they would exert upon them the same valuable influence that is secured by the presence and services of the superiors of these order; they would bring in a more respectable class of nurses and train them, which no men can do; they would supervise the domestic arrangement, and give the higher tone of womanly influence so greatly needed. . .

We come now to the position of women in medicine itself. The fact that more than half of ordinary medical practice lies among women and children, would seem to be, at first sight, proof enough that there must be here a great deal that women could do for themselves, and that it is not a natural arrangement that in what so especially concerns themselves, they should have recourse entirely to men. Accordingly we find that, from the very earliest ages, a large class of women has always existed occupying certain departments of medical practice. Until within half a century, a recognized position was accorded to them, and midwives were as distinct a class, as doctors. Even now, in most European countries, there are government schools for their instruction, where they are most carefully trained in their own specialty. This training is always given in connexion with a hospital, of which the pupils perform the actual practice, and physicians of standing are employed as their instructors. . . The whole ideal of their education, however, planned and molded entirely by men, was not to enable these women to do all they could in medicine, but to make them a sort of supplement to the profession, taking off a great deal of laborious poor practice, and supplying a certain convenience in some branches where it was disadvantageous to have the assistance of skillful women’s hands. With the advance of medical science, however, and its application to all these departments of medicine, this division of the directing head, and the subordinate hand, became impossible. Physicians dismissed, as far as possible, these half-educated assistants, excluded them from many opportunities of instruction under their authority, and in the government schools, which popular custom still upholds, they have materially curtailed their education. Nor is it possible to desirable to sanction the practice of any such intermediate class. the alternative is unavoidable of banishing women from medicine altogether, or giving them the education and standing of the physician. The broad field of gender medical science underlies all specialties, and an acquaintance with it is indispensable for the successful pursuit of every department. If the popular instinct that called women so widely to this sort of work represent a real need, it can only be met now by a class of women whose education shall correspond to the wider requirement of our present medical science.

Moreover, experience very soon shows that it is not these special branches of practice that will chiefly call for the attention of women in medicine. The same reason which especially qualifies women to be the teachers of women, in sanitary and physiological knowledge, viz., that they can better apply it to the needs of women’s’ life, holds good in regard to their action as physicians. . . At, present, when women need medical aid or advice, they have at once to go out of their own world, as it were; the whole atmosphere of professional life is so entirely foreign to that in which they live that there is a gap between them and the physician whom they consult, which can only be filled up by making the profession no longer an exclusively masculine one. Medicine is so broad a field, so closely interwoven with general interest, dealing as it does with all ages, sexes, and classes, and yet of so personal a character in its individual applications, that it must be regarded as one of those great departments of work in which the cooperation of men and women is need to fulfill all its requirements. It is not only by what women will do themselves in medicine, but also by the influence which they will exert on the profession, that they will lead it to supply the needs of women as it can not otherwise. . .

It is often objected to this ideal of professional and scientific pursuits for women that it is too much out of keeping with their general life, that it would not harmonize with their necessary avocations in domestic and social life; that the advantages to be gained from the services of women physician would not compensate for the injurious effect it would have upon the women themselves who pursued the profession, or the tendency it might have to induce others to undervalue the importance of duties already belonging them.

This objection, the prominent one which we usually meet appears to us based on an entire misapprehension what is the great want of women at the present day. All who know the world must acknowledge how far the influence of women in the home, and in society, is from what it should be. How often homes, which should be the source of moral and physical health and truth, are centers of selfishness or frivolity! How often we find women, well meaning, of good intelligence and moral power, nevertheless utterly unable to influence their homes aright. The children, after the first few years of life, pass beyond the influence of the mother. The sons have an entire life of which she knows nothing, or has only uneasy misgivings that they are not growing up with the moral truthfulness that she desires. She has not the width of view - that broad knowledge of life, which would enable her to comprehend the growth and needs of a nature and position so different from hers; and if she retain their personal affection, she can not acquire that trustful confidence which would enable her to be the guardian friend to their early manhood. Her daughters also lack that guidance which would come from broader views of life, for she can not give them a higher perception of life than she possesses herself. How is it, also with the personal and moral goodness attributed to woman, that the tone of social intercourse, in which she takes so active a part is so low? That, instead of being a counterpoise to the narrowing or self-seeking spirit of business life, it only adds an element of frivolity and dissipation. . .

. . . The more connections that are established between the life of women and the broad interests and active progress of the age, the more fully will they realize this wider view of their work. The profession of medicine which, in its practical details, and in the character of its scientific basis, has such intimate relations with these every-day duties of women, is peculiarly adapted as such a means of connection. For what is done or learned by one class of women becomes, by virtues of their common womanhood, the property of all women. It tells upon their thought and action, and modifies their relations to other spheres of life, in a way that the accomplishment of the same work by men would not do. Those women who pursued this life of scientific study and practical activity, so different from woman’s domestic and social life and yet so closely connected with it, could not fail to regard these avocations from a fresh stand-point, and see in a new light the noble possibilities which the position of woman opens to her; and though they may be few in number, they will be enough to form a new element, another channel y which women in general may draw in and apply to their own needs the active life of the age.

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