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Medicine as a Profession for Women (Elizabeth and Emily Blackwell)

For works with similar titles, see Medicine as a Profession for Women.

Medicine


as a


Profession for Women.




New York:
Printed for the Trustees of the
New York Infirmary for Women.


1860.



Medicine

as

a Profession for Women.[1]

In inviting consideration to the subject of medicine as an occupation for women, it is not a simple theory that we wish to present, but the results of practical experience. For fourteen years we have been students of medicine; for eight years we have been engaged in the practice of our profession in New York; and during the last five years have, in addition, been actively occupied in the support of a medical charity. We may therefore venture to speak with some certainty on this subject; and we are supported by the earnest sympathy of large numbers of intelligent women, both in England and America, in presenting this subject for the first time to the public.

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

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

Now, we believe that both these reasons are valid, and that experience will fully confirm them; but we believe also that there is a much deeper view of the question than this; and that the thorough education of a class of women in medicine will exert an important influence upon the life and interests of women in general, an influence of a much more extended nature than is expressed in the above views. The question of the real value to the community of what women may do in medicine is an eminently practical matter, for upon it is based the aid which they may ask for its accomplishment; and upon the position of women in medicine depends the kind and extent of education which should be given to fit them for it. A great deal of well-meant effort has been, and is still being expended upon the institutions which have been established for this purpose. Sometimes we have heard much discouragement expressed at the slight result that has followed from them; while, on the other hand, it is often said, "after all, it is a matter for women to settle for themselves, if they can be doctors, and want to, they will find the way to do it, there is no need of doing any thing in the matter." Now as I have said, we believe it to be by no means a matter concerning only the limited number of women who may be actually engaged in the pursuit itself; and it is also certain that to insure the success of the work it is not enough that women should wish to study, the coöperation and support of public sentiment is needed to enable them to do so. We hope, by showing the value of the work, to prove it to be the interest of the community to carry it out; and we desire to show the means by which this may be done.

Let me then say a few words on the influence which would be exerted on society by the opening of medicine as a profession to women. The interests and occupations of women, as they actually are at present, may be referred to four distinct forms of effort:—Domestic life; the education of youth; social intercourse, and benevolent effort of various kinds. All these avocations, by unanimous consent, are especially under the superintendence of women, and every woman, as she takes her place in society, assumes the responsibility of participation in some of them.

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

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

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

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

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

From the fact, then, that our lives must be directed more by reason than instinct, arises at once the necessity for a science of health, and that comprehension of it which will lead to its daily application. Take in illustration the simplest physical need, that which is most completely instinctive in its character—the question of food. Animals make no mistake on this point, being governed infallibly by instinct, but what conflicting theories it has given rise to among men! It is very rare to find among women, the heads of families, any clear idea of what are the requisites for a healthy table; and what is true of this very simple material want is still more so with regard to higher questions of physical law, those more intimately connected with the intellect and affections, and the family and social relations growing out of them. Nothing is more striking in a wide observation of daily life than the utter insufficiency of simple common sense to secure wise action in these matters. Numbers of people, of very good common sense in other things, violate the fundamental laws of health without knowing it; and when they think upon the subject they are just as likely to follow some crude popular theory as to find out the truth.

That progress is needed in sanitary matters is widely admitted; sanitary conventions are held; the medical profession and the press are constantly calling attention to defects of public and private hygiene, pointing out the high rate of mortality amongst children, etc.; but it is far from being as generally recognized how essential to progress it is that women, who have the domestic life of the nation in their hands, should realize their responsibility, and possess the knowledge necessary to meet it.

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

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

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

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

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

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

In Catholic countries this is accomplished to a certain extent—that is, as far as the domestic and nursing departments are concerned—by the religious orders, the sisters of charity and others. Every one who is familiar with such institutions must have been struck by the contrast between the continental and English hospitals, etc., caused by this one thing, by the cheerful and respectable home-like air of well-managed French establishments, as compared with the gloomy, common aspect of even wealthy English or American charities; and must have observed the salutary influence upon patients, students, and all connected with these places, of the presence and constant superintendence of women who, instead of being entirely common and subordinate, are universally regarded with respect and confidence, and by the poorer classes almost with veneration.

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

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

As we have said, every effort so far to introduce a corresponding class of women into English institutions has proved a failure, for there is no such organization in external life in Protestant churches as there is in the Catholic; it is contrary to the genius of the nation; and the same results would certainly follow in America.

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

They would be at the same time a connecting link between these establishments and women in general life, enlisting their interest and active services in their behalf, far more effectually than could be done by any other means. A real and great want would thus be supplied, and one which no other plan yet proposed has proved at all adequate to meet.

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

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

Our own experience has fully proved to us the correctness of this view. We find the practice, both public and private, which comes naturally to us is by no means confined to any special departments, and where patients have sufficient confidence in us to consult us for one thing, they are very apt to apply in all cases where medical aid is needed. The details of our medical work during the number of years that we have been connected with the profession can not be given to the public, but they have fully satisfied us that there will be the same variety in the practice of women as exists in that of men; that individual character and qualification will determine the position in practice, rather than pre-conceived ideas with regard to the position; and that there is no department in which women physicians may not render valuable services to women.

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

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

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

We have now briefly considered the most important grounds on which the opening of the profession of medicine to women is an object of value to society in general, and consequently having a claim upon the public for aid in its accomplishment. Let me now state briefly what are the means needed for this purpose.

The first requirement for a good medical education is, that it be practical, i. e., that the actual care of the sick and observation by the bedside should be its foundation. For this reason, it must be given in connection with a hospital. This essential condition is equally required for the more limited training of the nurse, which, though perfectly distinct in character and object from that of the physician, agrees with it in this one point of its practical nature. In Europe, the shortest period of study required for a physician's degree is four years, and at least ten months of each year must be spent in attendance upon the course of instruction. This course comprises not only lectures on the different branches of medicine, but thorough practical study of chemistry, botany, anatomy, etc., in the laboratory, gardens, museums, etc. Attendance on the hospitals is also required, where, for several years, the student is occupied with subordinate medical and surgical duty. This hospital training is the foundation of their education, and the lectures are illustrative of it, not a substitute for it. In England, no medical school can confer a degree that has not attached to it a hospital of as many as one hundred beds. And in many of the best schools, as that of St. Bartholomew's, of London, the college department will only number forty or fifty students, who perform all the assistants' duty of a hospital of five hundred beds, with an out practice of eighty thousand patients annually. In America, though so extensive and thorough an education is not legally required, yet all students who attain any standing in the profession pass through essentially the same course, because nothing short of it will enable them to meet the responsibilities of practice with success.

The chief difficulty in the way of women students at present is, as it always has been, the impossibility of obtaining practical instruction. There is not in America a single hospital or dispensary to which women can gain admittance, except the limited opportunities that have been obtained in connection with the New York Infirmary. This difficulty met us during our own studies, and we were obliged to spend several years in Europe to obtain the facilities we needed. Even there, no provision is made for the admission of women, but there are so many great hospitals in both London and Paris that only those distinctly connected with medical schools are crowded with students. There are many large institutions attended by distinguished physicians, comparatively little frequented by them, and in these a lady, with good introductions, can, if she will give the time and patience, find good opportunities for study.

This troublesome and expensive method is still the only way in which a woman can obtain any thing that deserves to be called a medical education, but it is evidently beyond the means of the majority of women. The instruction that they have hitherto been able to obtain in the few medical schools that have received them has been purely theoretical. It consists simply of courses of lectures, the students being rigorously excluded from the hospitals of the city, which are only open to men. Some three hundred women have attended lectures in these schools, the majority of them being intelligent young women, who would probably have been teachers had they not chosen this profession. They enter the schools with very little knowledge of the amount and kind of preparation necessary, supposing that by spending two or three winters in the prescribed studies they will be qualified to begin practice, and that by gaining experience in practice itself they will gradually work their way to success. It is not until they leave college, and attempt, alone and unaided, the work of practice that they realize how utterly insufficient their education is to enable them to acquire and support the standing of a physician. Most of them, discouraged, having spent all their money, abandon the profession; a few gain a little practical knowledge and struggle into a second-rate position. No judgment can be formed of women as physicians under such circumstances. It would be evidently an injustice to measure their capacity for such occupation by their actual success, when all avenues to the necessary instruction are resolutely closed to them.

Realizing the necessity of basing any system of instruction for women on actual practice, we resolved, seven years ago, to lay the foundation of such an institution as was needed. A number of well-known citizens expressed their approval of the undertaking, and kindly consented to act as trustees. We then took out a charter for a practical school of medicine for women. This plan was founded upon those of European hospital schools. It is as follows: To a hospital, of not less than one hundred beds, lectureships are to be attached, for the different branches of medical science, with clinical teachers to give instruction in the wards. The students should be connected with it for four years, and should serve as assistants in the house, and in out-door practice. Amongst the professorships attached to the hospital should be one of sanitary science, of which the object is to give instruction on the laws of health, and all points of public and private hygiene, so far as science and practical life have taught us with regard to them. This professor should also supervise the sanitary arrangements of the hospital itself, and should be the chief of the system of instruction for nurses. We believe that this professorship would be of real and important value, not only in giving the students a thorough acquaintance with the laws and conditions of health, and fully imbuing them with the idea that it is as much the province of the physician to aid in preventing as in curing disease, but also as affording to teachers and mothers the opportunity of obtaining that sort of knowledge which we have shown they so much need, and yet have no means of acquiring. In this hospital we would also establish a system of instruction for nurses. The plans for this instruction are based upon those drawn up by Miss Nightingale for her proposed nursing school in London,—plans, the result of her long and wide experience, which, unfortunately, her ill health will probably prevent her carrying out, but with which, though never yet published, we are well acquainted.

This is a slight sketch of the mode in which we wish to carry out the three-fold object of the institution, viz., the education of physicians, the training of nurses, and the diffusion of sanitary knowledge amongst women.

It is evident that to organize such a hospital school would be a costly undertaking. It could not be self-supporting, for students are generally barely able to pay for their own direct instruction; and the hospital foundation, the apparatus for teaching, and in the professorships, must be at least in part supported by endowment. It would require, therefore, a very large sum to organize such an institution of the size I have described, and it could not be efficiently carried out on a smaller scale, but could we awaken in the public a conviction of the value of the object, we believe that any amount really needed to accomplish it would be raised.

When we took out our charter we knew that, having few friends to aid in the effort, we must work gradually toward so large an end. We accordingly began the New York Infirmary, as a small dispensary, in a single room, in a poor quarter of the city, open but a few hours during the week, and supported by the contributions of a few friends. Three years ago we had grown sufficiently to take the house now occupied by the institution, No. 64 Bleecker street, and with the same board of trustees and consulting physicians we organized a small house department. This year the number of patients treated by the Infirmary is about three thousand seven hundred. Although the institution is much too small to enable us to organize any thing like a complete system of instruction for students or nurses, we have received into the house some of the elder students from the female medical schools, and a few women who have applied for instruction in nursing. We have thus become more familiar with their needs, and better able to shape the institution toward meeting them.

Although we can not yet realize the ultimate objects toward which we are working, the institution, even of its present size, is of very great value. In the first place, the fact that the entire medical practice of such an institution is performed by women is the best possible proof to the public of the possibility of the practice of women, since, being public in its character, its results are known, as those of private practice can not be. Secondly, it is already a valuable medical centre for women. The practice of a public institution, however small, establishes connexions between those who conduct it and others engaged in various public charities; and from the relations thus formed we have already been able to obtain facilities for students in the city dispensaries, and in private classes, that could not be obtained had we not such a centre to work from. Indeed, so effectual has it proved already in this manner, that were it established on a permanent basis, we could, by its assistance, and our connexions with the profession here and in Europe, enable individual students, possessing the requisite means, to obtain a good medical education before the institution itself can offer the complete education which I have described.

It is, moreover, a charity which is of much value to poor women, as being the only one where they can obtain the aid of women physicians. We have only been able to keep a very small number of beds, but they are constantly occupied by a succession of patients, and we could fill a much larger number if we were able to support them. Our dispensary practice is constantly increasing.

We believe, therefore, that, quite independent of the broader work that may be ultimately accomplished, in its present shape as a charity to poor women, as a proof of women's ability to practice medicine, and as a medical centre for women, this institution is well worthy of support.

What we ask from those who are interested in the objects we have stated is to assist in raising a fund for endowment which shall place the institution on a secure foundation. It has hitherto been supported almost exclusively by the subscriptions of a few friends, who pledged themselves for certain sums during three years. It has been a principle of management distinctly laid down, that the infirmary should not go into debt or on credit; that every year's expenses should be collected in advance, and should never be allowed to exceed the sum in the treasury at its commencement. This rule will be steadily adhered to, and no extension of operations undertaken until the funds are actually collected for that purpose. But so long as we are obliged to collect the income by subscription only from year to year we are not able even to lease a house, or make any arrangement for more than one year, but are obliged to devote to the work of its material support the time and attention that should be given towards organizing and furthering the objects of the institution. New York is the true centre of medical education. One hundred and fifty thousand patients received free medical aid last year; no other city in the Union compares with this in its need of medical charity. It is here, therefore, that a college hospital for women should be established. We have been urged to commence this work in England, and offers of valuable aid have been made for this purpose. But this medical work has originated here, and we believe that it is better suited to the spirit of this than of any other country. As America, therefore, has taken the initiative in this medical reform, let us do the work well.

I said to English friends before I left them, "You must send us over students, and we will educate them in America to do the same work in England." The cordial reply was, "We will send them over if we can not prevail upon you to return to us."

Now, therefore, America must help us to redeem the pledge of education which we have given in her behalf.

Help us to build up a noble institution for women, such an institution as no country has ever yet been blessed with, a national college hospital, in which all parts of the Union shall join. Let it not be a name merely, but a substantial fact, wisely planned and liberally endowed.

Surely this awakening desire of women to do their duty in the world more earnestly, and to overcome, for a great and good end, the immense difficulties which stand in their way, will enlist the sympathy and support of every generous man and woman.

Help us, then, friends! Join the little band of workers that has borne so bravely with us the odium of an unpopular cause. Help us fight this good fight, and achieve the victory, the victory of erecting a noble centre of instruction for women, which shall be not only a glory to the New World, but a blessing to the Old World too!

  1. This lecture was prepared by Drs. Elizabeth and Emily Blackwell, as an exposition of the effort now being made in this city to open the profession of medicine to women. It was delivered in Clinton Hall, on the 2d of December, 1859, and is now published at the request of the trustees of the New York Infirmary for Women.

This work was published before January 1, 1923, and is in the public domain worldwide because the author died at least 100 years ago.