You

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Youve come a long way baby.

• The History of Women in Medicine
• Amy Jost, class of 2004

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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?

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Women in Medicineearlier 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 worlds first named physician
• First woman known by name in history of science
• Described by her son, a high priest, as the
  chief physician

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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

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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

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The emergence of Nursing

• Nurses prior to late 1800s
• Did not require any training
• Were badly paid
• Didnt have a respectable reputation

• Enter Florence Nightingale
• In 1860 set up the first nurses training school
  at St. Thomass hospital
• Devoted life to improving hospital sanitation and
  establishing the profession of nursing

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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

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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.
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Florence Nightingales Polar Area Diagram
Designed to dramatize the needless deaths caused
by unsanitary conditions
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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."
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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.

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The Beardless LadDr. 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!!!

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Elizabeth Blackwell That girl there is doctor
in medicine!!!

• Americas first woman M.D.
• Received diploma January 23, 1849
• Her accomplishment was the result of years of
  determined effort

Elizabeth Blackwell, aged 38
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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!

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Discouragement on the road to becoming a doctor

• To earn money to support studies, Elizabeth
  turned to teaching and arranged to live in a
  physicians 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)

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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 Blackwells letter of admission
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First day of med school

• A lady, on his invitation, entered, whom he
  formally introduced as Miss Elizabeth BlackwellA
  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.
• (classmates memory of Blackwells first day)

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Life at Geneva Medical College

• The novelty of Elizabeths 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.
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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
  doctors 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.

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Anatomy Dissection always a delicate subject

• Elizabeths 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)

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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

Elizabeths diploma
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Life after medical school isnt 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
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Other women follow suit

• Despite protests from the medical community, many
  women followed Elizabeths lead
• Womens Medical College of Pennsylvania opened in
  1850 the first of several institutions devoted
  primarily to medical education of women

Womens Medical College of Pennsylvania
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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 Womens Medical College
  of the New York infirmary in 1868

Anatomy lecture room at the Womens Medical
College of New York Infirmary
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Struggle for co-education

• By the end of the 1800s, 19 womens medical
  colleges and 9 womens hospitals had been
  established.
• Harvard professor Edward H. Clarke (1874)
  proclaimed theories that women seeking advanced
  education would develop monstrous brains and
  puny bodiesand abnormally weak digestion.

Elizabeth B. Scott (1866-1958), Student at the
Woman's Medical College, Kingston, ca. 1888
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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
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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

Theres a woman doctor in the house cover of
German gazette, late 1800s
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Moving on into the 20th century

• Early 1900s saw a decline in the womens medical
  movement due to
• Medical education reform
• Closing of all but one of the womens 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
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Society in the 1950s

• In the 1950s there was a glorification of
  domesticity a womans primary role was that of
  a homemaker
• In 1949 (100 years after Elizabeth Blackwell!!),
  still only 5.5 of entering students were women!

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Enter into the 1960s

• 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

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Women in medicine recent decades

• A rise in women applying to medical school began
  in the 1970s due to
• Increase in medical schools and slots
• The Womens Movement
• The Equal Opportunity Act was passed
• Growing number of baby boomer girls were
  finishing college

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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

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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

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Still room for improvement

• Of the countrys 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

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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

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Medical School Graduates
16
14
12
10
Women
8
All
6
4
2
0
1960
1970
1980
1990
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U.S. Physicians 1970-2001
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Percent Distribution of Total US Physicians by
Age and Sex, 2001
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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
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What about the University of Chicago???
New Women Hires New Women Tenures faculty who are women professors who are women Tenured faculty who are women departures who are women division chiefs who are women department chairs who are women
University of Chicago 28 22 29 14 17 23 14 5
National Average 34 24 28 13 15 29 16 9
Source American Association of Medical Colleges
(AAMC) Statistics 2001-2002
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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!

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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