Sympathy and Science: Women Physicians in American Medicine

Table of Contents

Title Page

Copyright Page

Dedication

Preface

Acknowledgements

Introduction

CHAPTER 1 - Colonial Beginnings: Public Men and Private Women

CHAPTER 2 - The Middle-Class Woman Finds Health Reform

CHAPTER 3 - Bringing Science into the Home: Women Enter the Medical Profession

CHAPTER 4 - Separate but Equal: Medical Education for Women in the Nineteenth Century

CHAPTER 5 - Women and the Profession: The Doctor as a Lady

CHAPTER 6 - The Woman Professional: The Lady as a Doctor

CHAPTER 7 - Science, Morality, and Women Doctors: Mary Putnam Jacobi and ...

CHAPTER 8 - Doctors and Patients: Gender and Medical Treatment in ...

CHAPTER 9 - Hopes Unfulfilled: Women Physicians and the Social Transformation ...

CHAPTER 10 - The Emergence of Social Medicine: Women’s Work in the Profession

CHAPTER 11 - Integration in Name Only

CHAPTER 12 - Quo Vadis?

APPENDIX - Notes on Methodology

Bibliography

Notes

@ 1985 by Regina Morantz-Sanchez

Preface 0 2000 by Regina Morantz-Sanchez

All rights reserved

Manufactured in the United States of America

Originally published by Oxford University Press in 1985.

Published by the University of North Carolina Press in 2000.

The paper in this book meets the guidelines for permanence and durability of the Committee on Production Guidelines for

Book Longevity of the Council on Library Resources.

Library of Congress Cataloging-in-Publication Data Morantz-Sanchez, Regina.

Sympathy and science: women physicians in American medicine / Regina Morantz-Sanchez. p. cm.

Originally published: New York: Oxford University Press, 1985. Includes bibliographical references and index.

ISBN 0-8078-4890-5 (pbk.: alk. paper)

1. Women physicians—United States—History. 2. Physicians—United States—History. 3. Medicine—United States—History. 4. Social medicine—United States—History. 1. Title.

R692.M64 2000

610’.82’0973-dc21 00-027309

eISBN : 97-8-080-78760-8

The author is grateful to the following journals for permission to quote from her previously published articles: Making Women Modern: Middle-Class Women and Health Reform in 19th Century America, Journal of Social History 10 (June 1977); Professionalism, Feminism, and Gender Roles: A Comparative Study of Nineteenth-Century Medical Therapeutics, Journal of American History 67 (December 1980); Feminism, Professionalism and Germs: A Study of the Thought of Elizabeth Blackwell and Mary Putnam Jacobi, American Quarterly 34 (Winter 1982).

04 03 02 01 00 5 4 3 2 1

For

Maxwell M. Markell

zichrono l’vrachah

and

Adam Max Sanchez

1’Torah, u-1’chupah, u-1’maasim tovim

Preface

When Sympathy and Science was first published in 1985, women physicians comprised a mere 14 percent of the profession, although their numbers had been steadily rising since the 1970s. Today, predictions based on medical school enrollments suggest that this figure will reach 40 percent in the first third of the twenty-first century. The presence of women has also increased, although unevenly, in all specialties. It is no longer a shock to encounter a female surgeon, and the field of obstetrics and gynecology, once a male preserve because it was a surgical subspecialty, now attracts large numbers of female medical students. The rhetoric, ideas, and political activism of a resurgent feminist movement helped catalyze these changes, which have resolutely remapped the public landscape in the last thirty years. In addition, new federal and state antidiscrimination legislation and favorable court decisions responsive to decisive social and economic shifts have permanently altered women’s opportunities and aspirations in the professions, the world of work, and family life.

It has been more than three decades as well since new scholarship on women began to reconstruct the past in intriguing and innovative ways. Researchers commenced by exploring a broad range of topics, including women’s suffrage, changes in women’s role in the family, birth control and sexuality, women and abolitionism, colonial witch trials, nineteenth-century female moral reform, and women and work. This literature had become increasingly sophisticated by 1985, making that year an opportune time to publish the first comprehensive study of the history of women in the medical profession in the United States.¹ I was drawn to this topic because it touched on so many questions already being raised regarding the relationship of women to public and private life. At the time, American history was in the midst of a conceptual expansion that resulted in a radical explosion of fields of inquiry and innovative research methodologies. This emergence of what was called the new social history enabled investigators for the first time to examine medicine as an artifact of culture. The result was an influx into the history of medicine of young historians who were not physicians and whose view of history was shaped by the Thompsonian social-historical tradition. They linked medical subjects to histories written from the bottom up.²

I was one of those historians, though my interest in women physicians had a personal dimension as well. I understood that entering the academy would place me among the ranks of female professionals. I felt linked in some way with another set of female professionals, women physicians, whom I pictured as struggling to make it in a man’s world while attempting to meet the family obligations and role expectations American society imposed on all women. On some level, I believed that I could better comprehend my own private challenges by uncovering their long and complicated history. I was not disappointed.

My aspirations in writing Sympathy and Science were relatively straightforward. I wished to combine the best historical scholarship on women with the exciting new work being done in the social history of medicine, producing a volume that would appeal to experts in both fields. In addition, I wanted to offer a narrative spanning all of our nation’s history, one that would lay out a useful conceptual framework regarding women and the professions. Finally, I hoped to write a readable account that could appeal to both scholars and the larger public. Judging from the responses of colleagues, physicians, and general readers who have written and spoken to me enthusiastically over the years, I managed in some measure to meet these goals.

Sympathy and Science remains to date the most comprehensive analytical treatment of American women physicians over the last 300 years. Indeed, a range of subsequent scholarship has both expanded its insights and underscored its usefulness as a basic text. The narrative traces the history of women in the medical profession from the colonial period to the present. It recounts the participation of colonial women in healing as nurses, midwives, and practitioners of folk medicine, charts the successful struggles of women in the nineteenth century to enter medical schools and found their own institutions and organizations, and follows women doctors into the latter half of the twentieth century, when their dilemma has been primarily to sustain a significant and rewarding role as full-fledged medical professionals without sacrificing the other privileges and opportunities of womanhood. I argue that the entrance of women into the profession was a consequence of significant alterations in the social and economic realm in the late eighteenth and early nineteenth centuries, resulting in a transformation of family life and the social meaning of gender roles. Some women utilized these changes to insert themselves into public life, choosing a variety of venues. Nineteenth-century middle-class preoccupations with health and fitness created one possible outlet for many women activists, who used their expanded role as mothers to participate in a health reform movement that eventually led them to the conviction that women would make excellent doctors.

Though I carefully chronicle the strong public and professional opposition these women encountered, the book is primarily concerned with what women physicians, who by the turn of the twentieth century numbered almost 5 percent of the profession, managed to accomplish. I examine the hospitals and medical schools they founded. Equally important was their development of a female professional ethos. Their worldview was initially fashioned out of the assumptions of female moral superiority prevalent in the nineteenth century. This notion gave them needed self-confidence and helped many women doctors critique the gradual emergence of impersonal, dehumanized standards of scientific medicine and medical careerism. But it also threatened at times to marginalize them from mainstream professional developments. Indeed, by the last third of the nineteenth century and well into the twentieth, especially as women physicians struggled for an equal place in the profession, they found it more and more self-defeating to retain a perspective on medicine that emphasized their dissimilarities from male colleagues. Some female physicians indicted their sisters for perpetuating a false and outmoded notion of female difference that held them all back. Yet the story of their role in twentieth-century medicine, I argue, is still in large part that of continued wrestling with both the philosophical and cultural (as well as the mundane and practical) implications of what it means to be both a woman and a doctor.

Ironically, although historians of women in the 1970s were the first to grapple with the subject of women’s health and treatment in the past, U.S. scholars were slow to incorporate insights from the new social history of medicine into mainstream approaches to teaching and scholarship on women.³ Recent work in the history of the body stimulated by Foucault and feminist theory has, however, dramatically altered this situation. New scholarship committed to refined understandings of the links between power, domination, and resistance in the past has highlighted medicine as an auspicious site for studying complex negotiations between individuals, the professions, bureaucracies, and the state.⁴ Also significant in changing contemporary historical scholarship on women is the expansion of research guided by recent theoretical conceptions of gender. In light of these new perspectives, the present seems an appropriate moment to reexamine Sympathy and Science. How many of the ideas in the book are still useful, and how have they been modified or enhanced by new scholarly work?

Colonial Beginnings and Separate Spheres

In the chapters that deal with the colonial period and the nineteenth century, Sympathy and Science contends that white women’s status eventually improved by the second half of the nineteenth century, allowing them to contemplate entering the medical profession for the first time. When originally published, the evidence in Sympathy and Science buttressed the work of scholars who were calling into question prevailing assumptions about the existence of a colonial Golden Age—one in which women enjoyed myriad economic opportunities and were not yet subject to the constraints imposed by the rigid sex roles that emerged early in the nineteenth century.⁵ The relative openness of social relations in the seventeenth-century colonies, I maintained, did not provide women access to the medical profession. Women did, however, wield authority in the healing arts, most often as midwives, and childbirth was primarily a female-controlled event.

Subsequent scholarship has generally confirmed this view by elaborating on the complexity and unevenness of colonial women’s evolving position. For example, Laurel Ulrich’s A Midwife’s Tale treats us to a vivid rendering of the life and female social context of Martha Ballard, a highly respected and very successful midwife, but her story reaffirms my contention that neither medicine’s professional impotence in the colonies nor colonial tolerance of occasional gender flexibility enabled women to become licensed doctors.⁶ Subsequent research on the seventeenth and eighteenth centuries reinforces a multifaceted and occasionally contradictory portrait of female power and agency, while work on the revolutionary period has verified earlier suspicions that, for women, the end result of republican ideology was a strengthening of the separation of public and private life that led to their banishment from much scientific and intellectual endeavor. We understand even more clearly now why, as I argued fifteen years ago, colonial and revolutionary society was not ready to train women formally in medicine.⁷ Still, notwithstanding a recent emphasis on the ways republicanism could confine as well as liberate, Linda Kerber’s identification of the emancipatory elements of the ideology of Republican Motherhood and Nancy Isenberg’s exploration of the emergence of early women’s rights discourse have been helpful in enabling us to understand how some women negotiated more assertive identities in the nineteenth century.⁸

When Sympathy and Science was conceived in the mid-1970s, the dominant scholarly paradigm informing scholarship on the nineteenth century was the notion of separate spheres, which focused on white, middle-class, primarily northern women. As then understood, definitions of the concept were not only narrow, but race and class-biased. Historians explored white middle-class women’s troubled relationship to emerging concepts of public and private and their struggles to balance newly defined obligations in the domestic sphere with expanded educational opportunities and specifically female forms of public activity. In the beginning, much of the work concentrated on the prescribed aspect of these emergent roles, with less attention to how cultural ideologies actually structured women’s daily lives.⁹

By the early 1980s, however, historians had begun to expand their understandings of separate spheres, and Sympathy and Science was very much a part of this effort. Some scholars argued that women’s responsibilities in the bourgeois family eventually catapulted them into new avenues of endeavor, encompassing what has been termed quasi-political activity.¹⁰ Others emphasized women’s increasing participation in a vibrant consumer economy, underscoring my contention that women were conscientious consumers of health care.¹¹ Indeed, much of the continued contribution of Sympathy and Science lies in its detailed examination of how emerging economic and ideological complexities eventually led some women to pursue a medical education. My work on women physicians describes the ease and frequency with which many white middle-class women moved back and forth between family responsibilities and new forms of participation in the public sphere.¹² It shows how, by midcentury, some of them had already chosen to immerse themselves quite emphatically in both the family and the professionalizing world of science and medicine. Indeed, although many found this effort full of tension and contradiction—and justified their radical choices by utilizing a form of Victorian separate-spheres ideology—they fully believed that women physicians would build a bridge between those two spheres. A favorite story encapsulating their sometimes paradoxical solutions to difficult problems is that of Elizabeth Blackwell’s fierce battle to defy middle-class convention by entering medical school, followed by her refusal, after the successful completion of her course at Geneva Medical College two years later, to march in the graduation parade because to do so would be unladylike. How women such as Blackwell managed the personal and professional conflicts that arose out of their efforts is a major theme of the book.

Exploring Diversity

While researching women physicians’ lives, I was particularly struck by the multiplicity of their individual choices, within the constraints of prevailing gender and class regimes, a fact that helped to further revise separate-spheres theory. Although the large majority of female doctors practiced primarily among women and children, they lived in both cities and rural towns. Many were suffragists, while others were not; some involved themselves in female reform movements, including the women’s medical movement, but others avoided such activities. Some saw themselves as responsible for humanizing the profession; others merely hoped to make a decent living at work more interesting than teaching. Some were highly oriented to professional and scientific change, though a majority were content with general practice. Many believed that women should be trained in medicine to perform a unique role in the delivery of specialized care to women and children, while others hoped to be nothing more or less than family practitioners and were eager to integrate themselves totally into an increasingly masculinizing professional culture. In other words, women physicians were never a monolithic group, neither in their attitudes toward their place in the profession nor in their assumptions about politics, patient care, or the management of their own private lives.

In order to help illustrate the boundaries at the wide edges of this register of opinion and choice, I compared the differences in the careers and ideas of the two towering leaders of the nineteenth-century women’s medical movement, Mary Putnam Jacobi and Elizabeth Blackwell. In choosing these two, I sought to explore the range of opinions women doctors could harbor on the important role of the woman physician and her relationship to developments in late nineteenth-century scientific medicine. I argued that Blackwell focused primarily on women’s differences from men, while Jacobi spoke much more often of men’s and women’s shared characteristics.

Meanwhile, as scholars continued to revise and expand the paradigm of separate spheres to better explain women’s efforts at shaping their public and familial responsibilities in the nineteenth century, they highlighted what they described as tensions around separatism and integration, and sameness versus difference. I have already noted that nineteenth-women reformers and the institutions they created were often predicated on ideals of female difference and moral superiority. Indeed, Virginia Drachman argues in her study of the New England Hospital for Women and Children that separatism was a dominant or preferred strategy among the early generation of women doctors, who deliberately stayed within their own institutions.¹³ My research on women’s medical schools did not support this conclusion, although I readily acknowledge that many women hoped fervently, along with Elizabeth Blackwell, that female students would occupy positions in medicine that men cannot fully occupy and exercise an influence that men cannot wield at all.¹⁴ Moreover, I have argued that some of the disagreements between Blackwell and Jacobi over women’s role as doctors could be linked to their differing responses to advances in scientific medicine, and that developments in medicine influenced their thinking as powerfully as did Victorian ideologies about women. I was very clear in my discussion of these two pioneers that they represented a wide spectrum of attitudes and lifestyles. The chapter on Jacobi and Blackwell is richly augmented by two additional chapters of collective biography specifically intended to avert tendencies to interpret women doctors’ lives in simplistic dualisms. Rereading those chapters now confirms my view that they still destabilize tendencies to think about women physicians in terms of either/or.¹⁵

The efforts of Sympathy and Science to paint a rich and varied portrait of individual lives and accomplishments did not obviate my historian’s desire to understand what those lives had in common as well as how they differed from one another. Did enough women physicians practice an alternative kind of medicine or develop a particular professional style to allow us to conclude that women doctors diverged from their male colleagues in certain particulars? If they did not, does their story still deserve to be separated out from more general histories of the medical profession? What generalizations about women physicians could be made without violating my commitment to the diversity of their lives?

Sympathy and Science makes several inferences, having entered the emerging debates about gender just as it became useful to use the term.¹⁶ In discussions of women’s health and treatment, I separate notions of gender from an examination of women’s behavior. For example, most women physicians believed that they treated patients differently from men. My research confirmed this divergence, but not always in the ways women doctors or other historians would have liked to think. A comparative chapter on obstetrical treatment at two Boston hospitals—one run by men, the other by women—demonstrates, for example, that women doctors did live up to their self image as more empathetic attendants, suggesting that notions of gender affected their delivery of patient care. Women doctors interacted more often with patients in modest ways, prescribing supportive teas and mild drugs more frequently than their male colleagues. They exhibited a greater concern with patients’ social situations and took more steps to transition postpartum women into stable environments when they left the hospital. Yet in regard to significantly more controversial therapeutic interventions like the use of forceps, I found male and female doctors’ rates of usage to be similar.¹⁷

On the other hand, female doctors did produce an alternative discourse of women’s health and disease that countered, quite emphatically at times, dominant notions of female frailty. Gradually women physicians helped wean Victorian culture away from exaggerated assumptions about the negative role the female reproductive system played in dictating women’s health and disease. Women doctors also paid a good deal more attention than male doctors to preventive medicine, a fact in keeping with their argument that they had special contributions to make to the profession. They prided themselves on their interest in what I called social medicine, and linked it with the public image of the woman doctor, actively involving themselves in a network of public health institutions in the Progressive Era and beyond.

When Sympathy and Science was published, historians had not yet invented the term maternalist state to refer to late nineteenth- and early twentieth-century governmental changes brought about in response to women’s new public activism on behalf of mothers and children. But abundant research in this area in the last decade has both highlighted the importance of the activity I chronicled and located it squarely within new scholarly understandings of maternalist politics. It is clear from Sympathy and Science that women physicians, through their work in the Children’s Bureau, schools, and other public and private institutions, participated enthusiastically in shaping public health policy, including defining the boundaries of acceptable female adolescent behavior and helping to develop the ambiguous and ambivalent policies of protective constraint that historians like Linda Gordon, Mary Odem, Regina Kunzel, and others have recently explored.¹⁸ Though I also briefly described their participation in the birth control movement, eugenics, and the establishment of sex clinics, additional scholarly work is still needed in this area. Also welcome would be a more thorough examination of women doctors’ role in the political debates surrounding the welfare state in general and health care in particular.¹⁹

Women and Professionalization

In discussing the relationship of women to professionalization at the end of the nineteenth century and the beginning of the twentieth, Sympathy and Science highlights the tensions between prevailing concepts of femininity and the evolving professional ethos of scientific medicine. Though women did not choose to become doctors as often as they became teachers in the nineteenth century, medicine was their second most popular occupational preference. Hence, their response to changing developments in the field is an important piece of women physicians’ story. I argue that professionalization both encumbered and empowered them in complex ways. It empowered them by establishing an allegedly gender-free standard in which competence was measured by the successful completion of the requirements for a degree. As medical schools gradually opened their doors to women, the number of women doctors grew. But the professionalization process also hindered their progress, because embedded in that increasingly standardized life path was the foundational assumption that aspirants would invariably be men. Medical education and medical lifestyles were tailored to the male life cycle.

In addition, the definition of a medical professional became increasingly intertwined with more modem notions of scientific practice that validated a specific kind of inquiry—controlled laboratory experiments, counting and measuring results, the establishment of protocols of publication and replication. These novel methods of producing knowledge increasingly pushed definitions of the professional physician toward privileging those individuals who could best understand and be identified with experimental protocols and new technologies derived from the laboratory. These forms of knowledge were gendered male, while intuition and empathy were feminized. This development narrowed understandings of professionalism to such an extent that even the traditional bedside skills of male clinicians were often devalued. Medical practitioners such as midwives, whose expertise was grounded in artisanal knowledge and caregiving, lost out when the communities they served embraced doctors, who could more readily be identified with new models of disinterested science.²⁰

I suggest that women physicians responded to these conditions by developing a theory of female professionalism that helped them stake out a continued place for themselves. They hoped to counteract the masculinized notion of the skilled professional that gained heightened legitimacy with the ascendancy of modern science. Such efforts most often drew them toward feminine areas of endeavor: social hygiene and public health work, child-saving, gynecology, pediatrics, obstetrics.

The version of professionalism espoused by some women physicians, I suggest in Sympathy and Science, served to critique the narrow careerism and biomedical materialism that they found characteristic of their male colleagues, while also conflating traditional ideas about female self-sacrifice with aspects of an older nineteenth-century ideal—shared by both sexes earlier in the century—of the good practitioner. In subsequent publications I elaborated considerably on these themes.²¹ Other historians have taken them up as well. Robyn Muncy, for example, has utilized the idea of female professionalism to characterize the social strategies and political policies of many women activists in the Progressive Era.²² The fate of this style of female activism in the twentieth century, when sameness feminism clashed with and gradually supplanted nineteenth-century notions of female difference, is an integral part of my narrative, especially in the last chapters of the book.²³ Not surprisingly, contemporary scholars, women physicians, and other female professionals still grapple with these issues today.

Recent Scholarship

For lack of solid evidence, Sympathy and Science did not take up the question of African American women physicians. My research turned up occasional brief references to a handful of black women pioneers, but the important contextual work on African American women was just beginning when the book was published.²⁴ Indeed, it was about this time that feminist historians began to move away from a monolithic focus on white women as emblematic of all women’s experience and sought, in particular, to regain the history of black women.²⁵ Estimates suggest that about 115 African American women were trained in medicine by the turn of the century, compared to roughly 7,000 white women, several hundred black male doctors, and approximately 132,000 white men.²⁶

Unfortunately, there is still no book-length monograph on the subject of black women physicians, in large part because evidence from before the twentieth century remains difficult to find.²⁷ In 1985, Darlene Clark Hine began the task of historical reconstruction with an important article, and two years later Gloria Melnick Moldow published an account of the careers of both white and black female physicians in Gilded Age Washington, D.C. The presence in the nation’s capital of Howard University, which offered a coeducational medical course to both blacks and whites, allowed Moldow to provide something no other historian of women physicians or of black women has offered to date: an account of the social origins, professional training, and subsequent practice patterns of the city’s black women doctors, placed in the context of evolving professional developments.²⁸

In the last fifteen years, black women’s history has flourished, with several new works offering an evocative portrait of the complicated lives of African American women in the postemancipation period.²⁹ These studies have detailed, more than ever before, their problems and possibilities. Some have suggested that African American women struggled with too heavy a load as they worked to uplift the race. Always, they fought a battle on two fronts: for better economic and social conditions for all blacks and against the oppression of black women, not only in the larger culture, but also at home.³⁰

Equally valuable are studies of individual black women activists, white women’s reform politics, black women in the nursing profession and other medical institutions, and southern women.³¹ This scholarship has deepened our understanding of the rigid constraints white women’s institutional racism placed on black women’s access to professional and political development.³² For example, though Stephanie Shaw’s study of black women professionals does not deal directly with physicians, read in conjunction with this research on racism, it offers a stark contrast to my portrait of the daily lives of white women physicians. The struggle of the black community in the face of late nineteenth-century Jim Crow restrictions pervasively structured the education of black girls to communal responsibility, and Hine, Shaw, and others emphasize the power of this socialization. But the forced economic marginality of blacks, both North and South, coupled with educational and occupational discrimination, weakened the ability of black communities to adequately finance their own training institutions. These conditions help to explain why few black women—or black men, for that matter—became doctors. As Sympathy and Science notes, by the turn of the century medical education became increasingly more expensive, and the percentage of white women physicians became static, just as black women began entering a variety of professional occupations, including nursing.³³

Historians have found that, in spite of the patriarchal attitudes of many black men, black women both enjoyed and encouraged greater gender role flexibility within their own communities than did white women. Shaw’s work and other studies demonstrate that black women diverged from white women with respect to work/family patterns in intriguing ways. Future histories of black and white women physicians may uncover some striking differences. Equally noteworthy is the fact that historians have recently moved beyond attempts to supplement white models only by contrasting them with studies of black women. Many have begun to embrace a multicultural framework that emphasizes ethnic and racial diversity of all kinds, including a reevaluation of international boundaries.³⁴

Beyond these new areas of interest, most of the scholarly work published after Sympathy and Science has not challenged its conceptual framework, but rather developed, underscored, and amplified its themes.³⁵ For example, information on sectarian women, though still inadequately mined by scholars, has offered interesting contrasts between these women and regular female practitioners in terms of alternative theories of treatment, attitudes toward the emerging professional ethos, and physician-patient relations, which, among some sectarians, may have been more democratic.³⁶ Scholars have also begun to look more carefully at the relationship of women physicians to the new medical science that emerged at the end of the nineteenth century. Arleen Tuchman is substantially revising present interpretations of the career of Marie Zakrzewska, the founder of the New England Hospital for Women and Children. By highlighting Zakrzewska’s political and scientific background in her native Germany, Tuchman has been able to paint a more nuanced portrait of this enigmatic woman, hitherto imperfectly understood by scholars, while amplifying my discussions of the ties between women physicians and nineteenth-century science.³⁷

Another topic explored in Sympathy and Science that has benefited from recent feminist theoretical approaches is medical constructions of the female body and the related question of gender and medical treatment. While I have devoted considerable attention to both of these themes in my more recent work, other scholars have also paved the way for increasingly sophisticated approaches to questions we historians grappled with almost two decades ago. We now understand more clearly that the body has a history, and that medical and lay perceptions of anatomy, physical structure, and function are embedded in situated cultural milieus that are not universal, but change through time.³⁸ These insights have considerably enhanced our perceptions of doctors’ encounters with patients, another topic that has recently received increased attention.³⁹

In several articles and a newly published book, Ellen More revisits Sympathy and Science’s conclusions surrounding the complicated question of women physicians’ transition to the twentieth century. Focusing on the notion of striking a balance, she has expanded my depiction of the various strategies that modern women physicians—re— quired to function in an entirely different medical world from that of their nineteenth-century sisters—adopted to reconcile the dilemmas of equality and difference, not only as full-fledged professionals, but as wives, mothers, and daughters.⁴⁰ Recently published biographies and autobiographies have also proved invaluable for exploring these themes.⁴¹ Equally welcome is the first detailed scholarly history of the Woman’s Medical College of Pennsylvania, the institution that figured so centrally in my own narrative account of women physicians’ complicated struggle for access to equal medical education and expanding professional opportunities.⁴²

Comparative perspectives, exemplified by Thomas Bonner’s ambitious and insightful study of women’s medical education in Europe and the United States, have been especially important in understanding the complexities of American women’s access to training.⁴³ Bonner has demonstrated that, however severe the struggle for women who sought medical education in the United States, barriers lasted longer in Europe. In America, the absence of government regulation enabled women to found their own medical schools by midcentury or to attend the various sectarian schools that welcomed them. Primarily controlled by the state, however, most European universities did not allow women to take the medical degree until the end of the 1860s or the early 1870s. Thus, American women physicians outnumbered their European sisters by significant numbers in the nineteenth century. Many American women eventually sought further training in Europe, rightly convinced of the inferiority of the American system and suspicious of separate women’s schools. Ironically, though Europe was late to admit women to the degree, once the decision was taken by state initiative, the policy was protected by law. In contrast, the tradition of private sponsorship of medical education in America enabled U.S. medical schools to discriminate against women well into the twentieth century. While the number of women physicians steadily rose in Europe after 1900, reaching close to 20 percent in Germany by the early 1930s, in the United States the ratio of women doctors stagnated at around 5 percent until the 1960s. In Great Britain before World War II, the figure was double what it was in the United States, with an increase in female physicians since 1900 of 237 percent. As Bonner notes, though Europe and America similarly questioned women’s suitability for medicine, the relationship of the state to medical practice eventually determined women’s success. In Europe, state control held private prejudices in check and women benefited. In the United States, where institutions and licensing were more privatized, women often lost out in a complex but discernible way.⁴⁴

New Directions for Future Scholarship

Despite the high quality of new scholarship on women physicians, there is much left to be done. Though work in the last decade and a half has created a textured and sophisticated analysis of black women in various aspects of history that can serve as an excellent backdrop for further studies of black women in the medical profession, we still eagerly await a book-length study. We need to know more as well about the experiences of women of color in medical education and practice. Equally lacking is a better understanding of women’s role in sectarian medicine in the early years of the of the twentieth century.⁴⁵ Though I have recently elaborated in Conduct Unbecoming a Woman: Medicine on Trial in Turn-of-the-Century Brooklyn on the relationship between women physicians and the dominant paradigms of twentieth-century scientific medicine, the topic remains a rich area for further investigation, and the insights of feminist theorists and historians of science on the relationship between science and culture need further amplification.⁴⁶

Women’s historians have lately exhibited a great deal of interest in exploring the more recent past, especially women’s politics in the twentieth century. They have begun to trace the maternalist impulse through the period of the New Deal and beyond. This work has special relevance to the history of women physicians because of their enthusiastic participation in social medicine. It can help illuminate their differences from their male colleagues and sharpen our grasp of the interface between health concerns and social policy.⁴⁷ Missing from our view of twentieth-century developments is a longitudinal understanding of the relationship of women physicians to feminism or of the role the revived feminist movement of the 1960s played in stimulating contemporary women’s interest in the professions. How has feminism helped women doctors manage their ambivalent relationship to the dominant American professional ethos or to nonfeminine specialties, like surgery?⁴⁸

Contemporary feminism has also focused intensely on issues of women’s health. What has been the role of women physicians in this effort, and how have they benefited from it? And what of the relationship between women doctors and patients—female as well as male? Finally, though Sympathy and Science linked the history of women physicians to other fascinating topics in recent American history—the emergence of the welfare state and the ascendancy of managed care in the second half of the twentieth century (which provides women doctors with the work hours best suited to marriage and family), women and work, medical research (particularly on women’s health), gender relations, sexuality, marriage and family life—many of these subjects remain underexplored.

Optimists are buoyed by the likelihood that women physicians will achieve approximate parity with men in the twenty-first century. They celebrate as well the fact that women now comprise roughly 24 percent of the full-time faculty at U.S. medical schools. Gains have been dramatic and relatively swift. But, according to a study by the Association of American Medical Colleges, the extraordinary advances of the last thirty years are beginning to reach a plateau.⁴⁹ What this means for the future of women in medicine remains to be seen. At the very least, it suggests that though overt discriminatory practices have surely diminished, they are still present in muted form. Research on women and the professions suggests that work/family conflicts remain as frustrating as ever.⁵⁰ Moreover, it is worth contemplating that women have been invited into the profession at precisely the moment when perhaps the majority of their colleagues deplore the ascendancy of managed care and think that medicine is being degraded and deprofessionalized by the increasing primacy of cost/benefit analyses in determining the outcome of crucial decisions about treatment.

Two recently published autobiographies, both by women surgeons, suggest that in spite of extraordinary advances in the last three decades, women physicians will face the new century still grappling with many of the issues their predecessors could not resolve.⁵¹ Lori Arviso Alford made an extraordinary journey from life on a Navaho reservation to a career as a successful general surgeon and dean at Dartmouth Medical School. Reminding us of women physicians at the dawn of the twentieth century, her account articulates her ongoing struggle to balance the holistic approach to healing characteristic of her Native American heritage with the reductionist, organ-specific focus of Western medical care in general and her chosen specialty in particular. It contributes as well an interesting and important multicultural perspective. Meanwhile, in Walking Out on the Boys, the neurosurgeon Frances Conley chronicles how her efforts to be a success in her chosen specialty were thwarted by blatant incidents of gender discrimination, one of which occurred when she was at the pinnacle of her career, after having done everything right, including forgoing the possibility of children and more conventional forms of familial connection and self-development that might have encumbered her pursuit of professional advancement.

Both these books tell stories that carry extraordinary narrative power when read in the light of women physicians’ history. It is my hope that Sympathy and Science will continue to provide context for a new generation of historians, physicians, and individuals who believe in the contemporary value of retrieving the past.

Notes

I would like to thank Anne Lombard, Sue Juster, Anna Smith, Steve Peitzman, Michele Mitchell, Charlotte Borst, and, especially, Louise Newman and Barbara Bair for conversations, suggestions, and comments.

1 Two scholarly books on the history of women physicians in the United States preceded the publication of Sympathy and Science. Mary Roth Walsh’s Doctors Wanted: No Women Need Apply: Sexual Barriers in the Medical Profession, 1835-1975 (New Haven: Yale University Press, 1977), charted persistent discrimination against women physicians, dealing less directly with their lives and ccomplishments. Virginia Drachman’s Hospital With a Heart: Women Doctors and the Paradox of Separatism at the New England Hospital, 1862-1969 (Ithaca: Cornell University Press, 1984), focused on the history of one important New England training institution.

2 For an example of the new social history of medicine, see David Rosner and Susan Reverby, eds., Health Care in America: Essays in Social History (Philadelphia : Temple University Press, 1979), especially the introduction, Beyond the Great Doctors.

3 My informal impression is that this happened more readily in Great Britain in the 1970s and 1980s.

4 This scholarly literature is now extensive, but three anthologies might serve as introductions: Mary Jacobus, Evelyn Fox Keller, and Sally Shuttleworth, eds., BodylPolitics: Women and the Discourses of Science (New York: Routledge, 1990); Irene Diamond and Lee Quinby, eds., Feminism and Foucault: Reflections on Resistance (Boston: Northeastern University Press, 1988); and Alison M. Jaggar and Susan R. Bordo, eds., GenderlBodylKnowledge: Feminist Reconstructions of Being and Knowing (New Brunswick, N.J.: Rutgers University Press, 1989). Also essential reading are Thomas Laqueur, Making Sex: Body and Gender from the Greeks to Freud (Cambridge: Harvard University Press, 1990); Barbara Duden, The Woman Beneath the Skin: A Doctor’s Patients in Eighteenth-Century Germany (Cambridge: Harvard University Press, 1991); and Nancy M. Theriot, Mothers and Daughters in Nineteenth-Century America: The Biosocial Construction of Femininity (Lexington: University Press of Kentucky, 1996).

5 The argument is best made in Gerda Lerner’s classic article The Lady and the Mill Girl: Changes in the Status of Women in the Age of Jackson, American Studies 10 (Spring 1969): 5-15.

6 Laurel Ulrich, A Midwife’s Tale: The Life of Martha Ballard, Based on Her Diary, 1785-1812 (New York: Alfred A. Knopf, 1990).

7 See especially Kathleen M. Brown, Good Wives, Nasty Wenches, and Anxious Patriarchs: Gender, Race, and Power in Colonial Virginia (Chapel Hill: University of North Carolina Press, 1996); Cornelia Dayton, Women Before the Bar: Gender, Law and Society in Connecticut, 1639-1789 (Chapel Hill: University of North Carolina Press, 1995); Susan Juster, Disorderly Women: Sexual Politics and Evangelicalism in Revolutionary New England (Ithaca: Cornell University Press, 1994); and Linda Kerber, Toward an Intellectual History of Women (Chapel Hill: University of North Carolina Press, 1997), and No Constitutional Right to Be Ladies: Women and the Obligations of Citizenship (New York: Hill & Wang, 1998). See also Joan Landes, Women and the Public Sphere in the Age of the French Revolution (Ithaca: Cornell University Press, 1988), and Londa Scheibinger, The Mind Has No Sex?: Women in the Origins of Modern Science (Cambridge: Harvard University Press, 1989).

8 In the end, Kerber comes down on the side of the constraints of republicanism, but she also suggests ways in which women’s role as mothers could eventually link them with the state, while admitting that this link was always problematic. Linda Kerber, Women of the Republic: lntellect and Ideology in Revolutionary America (Chapel Hill: University of North Carolina Press, 1980), and No Constitutional Right to Be Ladies. Nancy Isenberg, Sex and Citizenship in Antebellum America (Chapel Hill: University of North Carolina Press, 1998).

9 Barbara Welter’s influential article The Cult of True Womanhood, American Quarterly 18 (Summer 1966): 151-74, was a major influence on and exemplar of this early stage of thinking on separate spheres. For my own early discomfort with this approach, which tended to see women primarily as victims, see Regina Morantz, The Lady and Her Physician, in Clio’s Consciousness Raised: New Perspectives on the History of Women, ed. Lois Banner and Mary Hartman (New York: Harper Torchbooks, 1973), 38-53.

10 Paula Baker, The Domestication of Politics: Women and American Political Society, 1780-1920, American Historical Review 89 (June 1984): 620-647. Baker’s article was stimulated by an abundant literature produced between the mid-1970s and the mid-1980s exploring, delineating, and analyzing this reformist activity.

11 On consumption, see, for example, Elaine Abelson, When Ladies Go A‘Thieving: Middle-Class Shoplifters in the Victorian Department Store (New York: Oxford University Press, 1989). For more on women as patient consumers, see Regina Morantz-Sanchez, Conduct Unbecoming a Woman: Medicine on Trial in Turn-of the-Century Brooklyn (New York: Oxford University Press, 1999), chap. 6.

12 For a theoretical development of this argument and a discussion of the history of this paradigm, see Linda Kerber, Separate Spheres, Female Worlds, Woman’s Place: The Rhetoric of Women’s History, Journal of American History 75 (June 1988): 9-39.

13 See below, chap. 4 for their suspicion of separatism.

14 See below, p. 196.

15 A few recent scholars have read into this discussion a kind of binarism that was emphatically absent from the original argument. Ellen More, for example, in an otherwise exemplary new study of women doctors, suggests that I explored the tension between two typologies of female professionalism: separatist perfectionism and collegial assimilation (More, Restoring the Balance: Women Physicians and the Profession of Medicine, 1850-1995 [Cambridge: Harvard University Press, 1999], 9).

16 Joan Scott’s Gender and the Politics of History (New York: Columbia University Press) was published in 1988. For a still-useful discussion of the differences in approach between gender history and women’s history, see Louise Newman, Critical Theory and the History of Women: What’s at Stake in Deconstructing Women’s History, Journal of Women’s History 3 (Winter 1991 ): 58-68.

17 Below, chap. 8. Contemporary studies note that women physicians probably spend slightly more time with patients and establish less hierarchical relationships with them while taking a history. Joan M. Altekruse and Susanne W. McDermott, Contemporary Concerns of Women in Medicine, in Feminism within the Science and Health Professions: Overcoming Resistance, ed. Sue V. Rosser (Oxford: Pergamon Press, 1987), 65-88; Steven C. Martin, Robert Arnold, and Ruth Parker, Gender and Medical Socialization, Journal of Health and Social Behavior 15 (1988): 161-205; K. D. Bertakis et al., The Influence of Gender on Physicians’ Practice Style, Medical Care 13 (1995): 407-16; and Ludwien Meeuwesen, Cas Schaap, and Cees van der Staak, Verbal Analysis of Doctor-Patient Communication, Social Science and Medicine 32 (1991): 1143-50.

18 On maternalism, see Sonya Michel and Seth Koven, Womanly Duties: Maternalist Politics and the Origins of Welfare States in France, Germany, Great Britain, and the United States, 1880-1920, American Historical Review 95 (October 1990): 1076-1109. The literature is now voluminous and these are only representative examples. See Linda Gordon, Heroes of Their Own Lives: The Politics and History of Family Violence, Boston, 1880-1960 (New York: Viking Press, 1988); Regina Kunzel, Fallen Women, Problem Girls: Unmarried Mothers and the Professionalization of Social Work, 1890-1945 (New Haven: Yale University Press, 1994); Mary Odem, Delinquent Daughters: Protecting and Policing Adolescent Female Sexuality in the United States, 7885-1920 (Chapel Hill: University of North Carolina Press, 1995).

19 There is nothing available that is as detailed on women physicians’ participation as, for example, Atina Grossmann’s compelling monograph on sex reform in Germany in this period. See Reforming Sex: The German Movement for Birth Control and Abortion Reform, 1920-1950 (New York: Oxford University Press, 1995).

20 For the link between the marginalization of midwives and the rise of professional science, see Charlotte G. Borst, Catching Babies: The rofessionalization of Childbirth, 1870-1920 (Cambridge: Harvard University Press, 1995). See also Regina Morantz-Sanchez, Feminist Theory and Historical Practice: ReReading Elizabeth Blackwell, History and Theory 31 (December 1992): 51-69. For a very interesting perspective on the complexity of the professionalization process, especially in terms of how its meritocratic values facilitated women’s opportunities even as the masculinization of subject matter and personal lifestyles held their progress in check, see Kirsten Swinth’s acute analysis of women in art, Painting and Professional: Women Artists and the Development of American Art (Chapel Hill: University of North Carolina Press: forthcoming).

21 Morantz-Sanchez, Feminist Theory and Historical Practice; The Gender]ing of Empathic Expertise: How Women Doctors Became More Empathic Than Men, in The Empathic Practitioner: Empathy, Gender, and the Therapeutic Relationslzip, ed. Ellen More and Maureen Mulligan (New Brunswick, N.J.: Rutgers University Press, 1994), 40-58; and Conduct Unbecoming a Woman, especially chap. 9.

22 Robyn Muncy, Creating a Female Dominion in American Reform, 1890 1935 (New York: Oxford University Press, 1991). Although not about women physicians, recent work on women and rofessionalization has complicated the narrative by carefully delineating class differences between female professionals and clients in ways suggested, but not always fleshed out, in Sympathy and Science. These works give us a clearer picture of the professional struggles twentieth-century women physicians coped with, especially those that required them to combat their own marginalization even as they worked to maintain a place in the field for the woman physician. See Patricia Hill, The World Their Household: The American Woman’s Foreign Mission Movement and Cultural Transformation, 1870-1920 (Ann Arbor: University of Michigan Press, 1985), and Linda Gordon, Heroes of Their Own Lives (New York: Viking, 1988). More recently, see Odem, Delinguent Daughters; Kunzel, Fallen Women, Problem Girls; and Elizabeth Lunbeck, The Psycluatric Persuasion: Knowledge, Gender and Power in Modern America (Princeton: Princeton University Press, 1994).

23 See Joan C. Williams, Sameness Feminism and the Work/Family Conflict, New York Law School Law Review 34 (March 1990): 347-60.

24 See Dorothy Sterling, ed., We Are Your Sisters: Black Women in the Nineteenth Century (New York: W. W. Norton, 1984), 440-50; Margaret Jerrido, Black Women Physicians: A Triple Burden, Medical College of Pennsylvania Alumnae Bulletin 30 (Summer 1979): 44-45.

25 See, for example, Bonnie Thornton Dill, Race, Class, Gender: Prospects for an All-Inclusive Sisterhood, Feminist Studies 9 ( Spring 1983): 131-50; Nancy Hewitt, Beyond the Search for Sisterhood: American Women’s History in the 1980’s, Social History 10 (October 1985): 299-321; Evelyn Brooks Higginbotham, Beyond the Sound of Silence: Afro-American Women’s History, Gender and History I (Spring 1989): 50-67, and African American History and the Metalanguage of Race, Signs 17 (Winter 1992): 251-74; and Antonia Castaneda, Women of Color and the Rewriting of Western History: The Discourse, Politics, and Decolonization of History, Pacific Historical Review (Winter 1992): 501-33.

26 H. Scott Turner, History of Women in Medicine, Los Angeles Journal of Eclectic Medicine 2 (1905): 125; Darlene Clark Hine, Physicians, Nineteenth Century, in Darlene Clark Hine, Elsa Barkley Brown, and Rosalyn Terborg-Penn, eds., Black Women in America: An Historical Encyclopedia (Bloomington: Indiana University Press, 1993), 2:923-26. See also Todd Savitt, Entering a White Profession: Black Physicians in the New South, Bulletin of the History of Medicine 61 (Winter 1987): 507-40, and ’A Journal of Our Own’: The Medical and Surgical Observer at the Beginnings of an African-American Medical Profession in Late 19th-Century America, Parts I and II, Journal of the National Medical Association 88 (1996): 52-60, 115-22.

27 See Darlene Clark Hine, Co-Laborers in the Work of the Lord: Nineteenth-Century Black Women Physicians, in Send Us a Lady Physician: Women Doctors in America, 1835-1920, ed. Ruth J. Abram (New York: W. W. Norton, 1985), 107-20. This lack does not exist for the twentieth century. To my knowledge, more work on black women physicians is presently being done by Hine and Vanessa Northington Gamble, M.D., Ph.D., professor of the history of medicine at the University of Wisconsin. As scholarly supervisor of The Oral History Project on Women and Medicine sponsored by the Archives on Women in Medicine of the Medical College of Pennsylvania, 1975-79, I, along with another interviewer, completed lengthy oral autobiographies of four black women physicians of different ages and specialties. One, the story of Vanessa Northington Gamble, was published in Regina Morantz, Cynthia Pomerleau, and Carol Fenichel, eds., In Her Own Words: Oral Histories of Women Physicians (Westport, Conn.: Greenwood Press, 1982). Full transcripts of interviews with Gamble (March 15, 1978), a medical student at the time, Dr. Dorothy Brown (February 27, 1978), Dr. Victoria Nichols (March 24, 1978), and Dr. Jeanne Spurlock (June 2, 1978) are on deposit at the Archives on Women in Medicine, Medical College of Pennsylvania, Philadelphia. Radcliffe Women’s Archives also commissioned several oral autobiographies of this kind, and the transcript of my interview with Dr. Eleanor Makel (January 21, 1983) is located at the Schlesinger Library. Fortunately, there are also a number of biographies and autobiographies available for the twentieth century. See, for example, Sara Lawrence Lightfoot, Balm in Gilead: Journal of a Healer, Radcliffe Biography Series (New York: Addison Wesley, 1988).

28 Hine, Co-Laborers in the Work of the Lord. Gloria Melnick Moldow, Women Doctors in Gilded Age Washington: Race, Gender, and Professionalization (Urbana: University of Illinois Press, 1987).

29 See, for example, Evelyn Brooks Higginbotham, Righteous Discontent: The Women’s Movement in the Black Baptist Church, 1880-1920 (Cambridge: Harvard University Press, 1999); Deborah Gray White, Too Heavy a Load: Black Women in Defense of Themselves, 1894-1994 (New York: W. W. Norton, 1999); Tera Hunter, To ‘Joy My Freedom: Southern Black Women’s Lives and Labors after the Civil War (Cambridge: Harvard University Press, 1997); Darlene Clark Hine, Black Women in White: Racial Conflict and Cooperation in the Nursing Profession, 1890-1950 (Bloomington: Indiana University Press, 1989); Nell Painter, Standing at Armageddon The United States, 1877-1919 (New York: W. W. Norton, 1987); Rosalyn Terborg-Penn, African American Women in the Struggle for the Vote, 1850-1920 (Bloomington: University of Indiana Press, 1998); Glenda Gilmore, Gender and Jim Crow: Women and the Politics of White Supremacy in North Carolina, 1896-1920 (Chapel Hill: University of North Carolina Press, 1996); Stephanie Shaw, What a Woman Ought to Be and Do: Professional Women Workers During the Jim Crow Era (Chicago: University of Chicago Press, 1996); and Susan L. Smith, Sick and Tired of Being Sick and Tired: Black Women and the National Negro Health Movement, 1915-1950 (Philadelphia: University of Pennsylvania Press, 1995).

30 For an excellent discussion of the larger context of race uplift ideology see Kevin Gaines, Uplifting the Race: Black Leadership, Politics, and Culture in the _Twentieth Century (Chapel Hill: University of North Carolina Press, 1996). For an excellent analysis of recent historiography on African American gender and sexual relations, see Michele Mitchell, Silences Broken, Silences Kept: Gender and Sexuality in African-American History, Gender and History 1 (November 1999): 433-44.

31 See, for example, Gail Bederman, Manliness and Civilization: A Cultural History of Gender and Race in the United States, 1880-1917 (Chicago: University of Chicago Press, 1995); Louise Newman, White Women’s Rights: The Racial Origins of Feminism in the United States (New York: Oxford University Press, 1999); Hine, Black Women in White; Vanessa Northington Gamble, Making a Place for Ourselves: The Black Hospital Movement, 1920-1945 (New York: Oxford University Press, 1995); Jacquelyn Dowd Hall, Revolt against Chivalry: Jessie Daniel Ames and the Women’s Campaign against Lynching (New York: Columbia University Press, 1979).

32 Interestingly, the Woman’s Medical College of Pennsylvania, partly because it was a Quaker-founded school, had an exemplary record on admitting black women and other racial minorities. See Steve Peitzman, A New and Untried Course: Womazz’s Medical College and Medical College of Pennsylvania, 1850-1998 (New Brunswick, N.J.: Rutgers University Press, 2000).

33 See Shaw, What a Woman Ought to Be and Do, and Hine, Black Women in White. See also Natalie J. Sokoloff, Black and White Women in the Professons: Occupational Segregation by Race and Gender, 1960-1980 (New York: Routledge, 1992).

34 See Castaneda, Women of Color, and several of the essays in Chandra Mohanty, Ann Russo, and Lourdes Torres, eds., Third World Women and the Politics of Feminism (Bloomington: Indiana University Press, 1991). See also Barbara Bair and Susan E. Cayleff, eds., Wings of Gauze: Women of Color and the Experience of Health and Illness (Detroit: Wayne State University Press, 1993). For sketches of black women physicians in the twentieth century, see More, Restoring the Balance.

35 See, for example, Gail L. McDaniel, Women, Medicine, and Science: Kansas Female Physicians, 1880-1910, Kansas History 21 (Fall 1998): 102-17.

36 See Jane Donegan, Hydropathic Highway to Health: Women and Water Cure in Antebellum America (Westport, Conn.: Greenwood Press, 1986); Susan Cayleff, Wash and Be Healed: The Water-Cure Movement and Women’s S’ Health (Philadelphia: Temple University Press, 1987). See also Naomi Rogers, Women and Sectarian Medicine, in Women, Health, and Medicine in America: A Historical Handbook, ed. Rima Apple (New York: Garland Publishing, Inc., 1990), and Clark Davis, Called by God, Led by Men: Women Face the Masculinization of American Medicine at the College of Medical Evangelists, 1909-1922, Bulletin of the History of Medicine (Fall 1993): 119-48.

37 See Arleen Tuchman, ‘Only in a Republic Can it Be Proved That Science Has No Sex’: Marie Elizabeth Zakrzewska and the Multiple Meanings of Science in the Nineteenth-Century United States, Journal of Women’s History 11 I (Spring 1999): 121-42. Tuchman is writing a biography of Zakrzewska. Also interesting in this regard is Susan Wells, Out of the Deadhouse: NineteenthCentury Women Physicians and Their Writing of Medicine (Madison: University of Wisconsin Press, 2000).

38 The work of Foucault has been essential here. Studies that have been particularly helpful to me include the following: Duden, The Woman Beneath the Skin; Theriot, Mothers and Daughters in Nineteenth-Century America; Laqueur, Making Sex; Joan Brumberg, Fasting Girls: The Emergence of Anorexia Nervosa as a Modern Disease (Cambridge: Harvard University Press, 1988); and several of Sander Gilman’s monographs, including Disease and Representation: Images of Illness from Madness to AIDS (Ithaca: Cornell University Press, 1988). Wonderfully provocative is Rachel P. Maines, The Technology of the Orgasm: Hysteria, the Vibrator, and Women’s Sexual Satisfaction (Baltimore: Johns Hopkins University Press, 1999). See also Morantz-Sanchez, Conduct Unbecoming a Woman, chap. 5.

39 See Alexandra Dundas Todd, Intimate Adversaries: Cultural Conflict between Doctors and Women Patients (Philadelphia: University of Pennsylvania Press, 1989); Wendy Mitchinson, The Nature of Their Bodies: Women and Their Doctors in Victorian Cartada (Toronto: University of Toronto Press, 1991); Patricia A. Vertinsky, The Eternally Wounded Woman: Women, Doctors, and Exercise in the Late Nineteenth Century (New York: St. Martin’s Press, 1990); Nancy Theriot, Women’s Voices in Nineteenth-Century Medical Discourse: A Step Toward Deconstructing Science, Signs 19 (Autumn 1993): 1-31; Morantz-Sanchez, Conduct Unbecoming a Woman, chap. 6. See also my Comment: Negotiating Power at the Bedside: Nineteenth-Century Patients and Their Gynecologists, forthcoming in Feminist Studies.

40 See Ellen More, The Blackwell Medical Society and the Professionalization of Women Physicians, Bulletin of the History of Medicine 61 (Winter 1987): 603-28; and ‘A Certain Restless Ambition’: Women Physicians and World War I, American Quarterly 41 (December 1989): 636-60; and Restoring the Balance, where she offers a number of important biographical sketches.

41 See, for example, Joycelyn Elders, M.D., From Sharecropper’s Daughter to Surgeon General of the United States ofAmerica (New York: Morrow, 1996); Mary Canaga Rowland, As Long as Life: The Memoirs of a Frontier Woman Doctor (Seattle: Storm Peak Press, 1994); Doc Susie (Carpenteria, Calif.: Manifest Publications, 1991); Eva Salber, The Mind Is Not the Heart: Recollections of a Woman Physician (Durham: Duke University Press, 1989); Beulah Parker, The Evolution of a Psychiatrist (New Haven: Yale University Press, 1987); Ellen Lerner Rothman, White Coat: Becoming a Doctor at Harvard Medical School (New York: William Morrow, 1999); Perri Klass, A Not Entirely Benign Procedure (New York: G. Putnam & Sons, 1987); Morantz, Pomerleau, and Fenichel, In Her Own Words; Frances K. Conley, M.D., Walk-ing Out on the Boys (New York: Farrar, Straus and