Previous to the enactment of this law, however, women assistants had served for a year at the Willard Asylum for the chronic insane,[[135]] and in 1888, two other women, Dr. Steadman and Dr. Wakefield, were appointed in the New York City Asylum on Blackwell’s Island. Similar appointments have been voluntarily made in ten other States, and more than twenty women are now serving as physicians in insane asylums.[[136]] The latest appointment was the greatest innovation, for it was in a Southern State, Virginia, at Staunton, and a Southern candidate, Miss Dr. Haynes, was appointed.[[137]] The Springfield Republican concludes its notice of this event (see note), with the remark: “This reform is steadily advancing, and it will not be long before the opposition to it will be as obsolete as it is now indecent.”[[138]]
Thus the last word, (so far) like the first in this long controversy, is indecency. And it is characteristic of the world-old social position of women that it should be so; since women have in the mass, never been publicly and officially regarded as individuals, with individual rights, tastes, liberties, privileges, duties, and capacities, but rather as symbols, with collective class functions, of which not the least was to embody the ideals of decorum of the existing generation, whatever these might happen to be. These ideals once consigned to women, as to crystal vases, it became easier for men to indulge their vagrant liberty, while yet leaving undisturbed the general framework of order and society. But all the more imperative was it, that the standard of behavior, thought, and life for women should be maintained fixed and immovable. Any symptom of change in the status of women seems, therefore, always to have excited a certain terror. This is analogous to the fierce conservatism of savage communities, ready to punish by death the slightest deviation from established custom, because, as Mr. Bagehot observes, without such strenuous care their entire social structure is liable to fall to pieces. It is perfectly evident from the records, that the opposition to women physicians has rarely been based upon 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. Failure could be pardoned them, but—at least so it was felt in anticipation—success could not. Apart from the absurd fear of pecuniary injury, which was only conceivable so long as women were treated, not as so many more individuals in the community, but as a separate class, and a class alien to men of their own race and blood and even family,—apart from this consideration, the arguments advanced have always been purely sentimental. There has always been a sentimental and powerful opposition to every social change that tended to increase the development and complexity of the social organism, by increasing the capacities and multiplying the relations of its members. The opposition to women physicians is, in its last analysis, only one of the more recent manifestations of this universal social instinct. So true is this, that in the strife physicians have abandoned the sentiments proper to their own profession, and have not hesitated to revile and defame it, in order to prove that it was unfit for the delicacy or virtue of woman. They have forgotten the tone of mind, the special mode of vision that becomes habitual to every one who has really crossed the threshold of the sublime art; they have talked of “revolting details” and “disgusting preliminaries,” like the veriest outside Philistine. There are horrors in medicine, because there are horrors in life. But in medicine these are overcome or transformed by the potency of the Ideal; in life they must be borne unrelieved. The women, who, equally with men, are exposed in life to the fearful, the horrible, the disgusting, are equally entitled to access to those regions of knowledge and ideas, where these may be averted, or relieved, or palliated, or transformed.
Again: A mother occupied with her young child offers a spectacle so beautiful and so touching, that it cannot fail to profoundly impress the social imagination. Contemplating this, it is easy to feel that all the poetry and romance, all the worth and significance of women are summed up in the exquisite moments of this occupation; easy to dread the introduction of other interests lest the women be unduly diverted from this, which is supreme. Yet nothing is more obvious than that diversion comes, a thousand times, from frivolity, but never through work; and that these moments are preceded by many years, and followed by many years, and for many women, through no fault of their own, never come at all. The seventy years of a life-time will contain much waste, if adjusted exclusively to the five or six years of even its highest happiness. The toiling millions of women of every age of the world have not been permitted to make such an adjustment, even if they should wish to do so. They have always worked; but they demand now, and simply, some opportunity for a free choice in the kind of work, which, apart from the care of children, they may perform. The invasion of the medical profession is one of the more articulate forms of this demand.
Although, according to the census of 1880, there were 2432 women registered as physicians throughout the United States, and several hundred must have graduated in the last ten years, it is probable that many of them have received an education too irregular and imperfect to justify their claim to the title in any serious sense. Thus the numbers are still too small, the time too short, to begin to estimate the work of women physicians. A large number of the women recorded in the census tables will not be found among the graduates of any suitable colleges, or on the registered lists of regular physicians, and these cannot be counted in an estimate like the present. Thus the census of 1880 records 133 women physicians in New York, but the medical register of ten years later contains the names of but 48. There seem to be about fifty at present in Philadelphia, twenty or thirty in Boston. Eighteen are said to be practicing in Detroit. The great majority are scattered through the country in small towns or country villages.
It is irrelevant to inquire with Waldeyer, “What women have done?” from the scientific standpoint, because the problem given was to enable them to become observant, faithful, and skillful practitioners of medicine, and this is possible without the performance of any really scientific work.
It is premature to make such inquiries, except for single cases which serve to illustrate the possibility, for it is but little more than a generation that the first school was opened to women; it is not more than a dozen years since the official education attainable has approached any degree of effectiveness. What women have learned, they have in the main taught themselves. And it is fair to claim, that when they have taught themselves so much, when they have secured the confidence of so many thousand sick persons, in the teeth of such vigorous and insulting opposition, and upon such scanty resources and such inadequate preparation; when such numbers have been able to establish reputable and even lucrative practice, to care for the health of many families over long terms of years, to sustain medical institutions of their own, almost exclusively dependent upon the good-will of citizens who have closely watched their work,—to serve in public hospitals in competition with men, to care for many thousands of sick poor, to whom abundant other medical aid was accessible, had it been preferred,—to restore to health many thousand women who had become helpless invalids from dread of consulting men physicians, or from delay in doing so,—to hold their own in private practice, in matters of judgment, diagnosis, medical and operative treatment, amidst the incessant and often unfair rivalry of brother competitors,—to do all this, we repeat, itself demonstrates a very considerable, indeed an unexpected amount of native ability and medical fitness on the part of women. With longer time, with more solid and varied opportunities, and with extension to the many of those which have hitherto been shared only by a very few, the amount of work accomplished may certainly be expected to increase, and in geometrical progression.
It could be wished that space remained to bring to light the obscure heroisms of the many nameless lives, which have been expended in this one crusade. It has been fought, and modestly, in the teeth of the most painful invective that can ever be addressed to women,—that of immodesty. Girls have been hissed and stampeded out of hospital wards and amphitheaters where the suffering patient was a woman, and properly claiming the presence of members of her own sex; or where, still more inconsistently, non-medical female nurses were tolerated and welcomed. Women students have been cheated of their time and money, by those paid to instruct them: they have been led into fields of promise, to find only a vanishing mirage. At what sacrifices have they struggled to obtain the elusive prize! They have starved on half rations, shivered in cold rooms, or been poisoned in badly ventilated ones; they have often borne a triple load of ignorance, poverty, and ill health; when they were not permitted to walk, they have crept,—where they could not take, they have begged; they have gleaned like Ruth among the harvesters for the scantiest crumbs of knowledge, and been thankful. To work their way through the prescribed term of studies, they have resorted to innumerable devices,—taught school, edited newspapers, nursed sick people, given massage, worked till they could scrape a few dollars together, expended that in study,—then stepped aside for a while to earn more. After graduating, the struggle has continued,—but here the resource of taking lodgers has often tided over the difficult time.
These homely struggles,—the necessity in the absence of State aid, of constantly developing popular support and sympathy for the maintenance of the colleges and hospitals, has given a solidity, a vitality to the movement, which has gone far toward compensating its quaint inadequacies and inconsistencies. On the European continent, the admission of women to medical schools has depended on the fiat of government bureaus, prepared in this matter to anticipate a popular demand, and to lead rather than to follow public opinion. In America, as in England, the movement for such extension of privilege has sprung from the people, it has fought its way,—it has been compelled to root itself in popular sympathy and suffrage. Hence a feeling of enthusiasm widely diffused among the women students, the sense of identification with an impersonal cause, whose importance transcended that of their individual personal fortunes, and yet which could only be advanced by the accumulation of their individual successes. The ill-taught girls at Chicago, who, sure in advance of defeat, resolved to face ridicule and contempt at the competitive examinations, in order to make a road for their successors, really exhibited, in a moral sphere, the heroism of Arnold Von Winklereid on the old Swiss battlefield.
The change from the forlorn conditions of the early days has been most rapid, and those who survived the early struggle, and whose energies were not so absorbed by its external difficulties that not enough were left for the intrinsic difficulties of medicine, have been really invigorated by the contest. Indeed one of the ways in which women have secured the infusion of masculine strength essential to their success, has been by successfully resisting masculine opposition to their just claims. It is as in the fable of Antæus,—those knocked down to the earth gained fresh strength as they touched the ground. The character and self-reliance natural to American women have thus been reenforced even by the adverse circumstances of their position. And, conversely, those for whom circumstances of fortune and education have been apparently the most propitious, even those who have received the best theoretical education, have not unfrequently been distanced, or even dropped altogether out of the career, because of an incurable dilettantism, for which the remedy had not been found either in practical hardship or in native intellectual vigor.
Efforts have several times been made to estimate the actual proportion of markedly successful practitioners among the women now engaged in medicine.[[139]] The two monographs cited below are both based upon circulars of questions sent out to as many women physicians as possible.[[140]] The answers to these inquiries are necessarily very partial, and can be quoted rather as illustrations than as statistics. Among such illustrations, the statements of the pecuniary results of practice are interesting. Dr. Bodley received answer from 76 ladies, and their total annual income, if divided equally among the 76, amounted to about $3000.[[141]] Among these, however, ten earned between $3000 and $4000 a year, five between $4000 and $5000, three between $5000 and $15,000, and four between $15,000 and $20,000.