S T A N F O R D M E D I C I N E
Volume 17 Number 3 FALL 2000
If a woman wanted to become a doctor in California in the late 1800s, Stanford's medical school was one of the few she could attend.
By Constance M. Chen
FROM STANFORD'S VERY EARLIEST DAYS, FEMALE STUDENTS HAVE POPULATED THE CLASSROOMS OF ITS MEDICAL SCHOOL -- ONE OF THE FEW PLACES IN CALIFORNIA WOMEN COULD STUDY TO BECOME DOCTORS IN THE LATE 1800s. These early female medical students would surely be astonished to see today's Stanford medical school classrooms, with women making up more than half of the typical class. A look at Stanford's history of educating women physicians shows how the times have changed.
On May 29, 1876, Professor William Wenzell of the chemistry department motioned that the faculty of the precursor to Stanford's medical school, temporarily called the Medical College of the Pacific, vote to admit women on equal terms with men. Professor Adolph Barkan of the ophthalmology department seconded the motion. There was no debate. The Medical College of the Pacific -- later to become Stanford University School of Medicine -- became the second medical school in California to train women to become physicians.
Not long before, women who had wanted to become physicians needed to find a men's medical school that would allow an exception and grant a degree to a female candidate, or attend a medical school established for women only. America's first woman doctor, Elizabeth Blackwell, had graduated fewer than three decades earlier, in 1849, from Geneva Medical College in New York -- which had bent the rules to grant the degree. In 1850, the first medical school for women, the Women's Medical College of Pennsylvania, was founded in Philadelphia. In 1864, Rebecca Lee, the first African-American woman doctor, graduated from the New England Female Medical College in Boston. In 1870, the University of Michigan became the first state medical school to fully accept women.
Soon West Coast medical schools began accepting women as well. The University of California was the first, with Stanford's precursor just a few years behind. In 1873, UC acquired the Toland School in San Francisco and, as UC was already co-educational, Toland accepted Maria Field Wanzer that year as its first female medical student. Three years later, Wanzer became the first woman graduate of a West Coast medical school. The same year, in 1876, Alice Boyle Higgins became the first woman to enter the Medical College of the Pacific, at age 40. Married since the age of 16 to William Morris Higgins, who was a registered pharmacist, Alice Higgins had three children. In 1877 she graduated from Medical College of the Pacific, and in 1881 and 1882 she went to the Women's Medical College of Pennsylvania, where she took a postgraduate course and was made an honorary member of the College's alumnae association. Offered to chair the anatomy department, she declined and returned to her family and opened an office in California.
Higgins became the pioneer woman doctor in Orange County, successful and with a large practice. Writing about Higgins in the Gazette after her death, a friend noted, "Impecunious patients were never refused medical advice; medicine was also supplied, and often the means to live until the patient was restored to health. Nor could the ingratitude of one or more of her patients harden her heart toward the next applicant for aid. She was too large-minded for that. For every fault she found an excuse, and thereby kept her sympathies always fresh and green." The writer further commented that "from early childhood she evinced a taste for the medical profession. As she grew into womanhood, she developed rare talents in that line."
Higgins was soon followed by other female medical students at Stanford's precursors. In 1877, Anabel McGaughey Stuart was admitted to the Medical School of the Pacific; in 1878 she became its second woman graduate in 1878. In 1882, the school was renamed Cooper Medical College, and by 1884 four out of the 16 members of the graduating class were female. In the 1880s and 1890s, the percentage of women in the medical school class ranged between 5 and 25 percent, and by the turn of the century women had established a lasting presence. The Cooper Medical College Class of 1899 boasted 10 women and 34 men in its graduating class (23 percent).
THE WOMEN OF THIS ERA SOMETIMES FELT RESPONSIBLE FOR REPRESENTING THEIR SEX ADEQUATELY. IN RECOLLECTIONS OF COOPER MEDICAL COLLEGE: 1883-1905, MARY BENNETT RITTER, CLASS OF 1886, recounted a particularly gruesome operation involving a cancer of the face during which the men fainted one after another and then were stretched out on the floor where nobody paid any further attention to them. Clenching her hands, Ritter noticed a senior woman student standing next to her swaying and turning "greenish-white." Defying the rule of silence in the operating theater, Ritter hissed into her companion's ear, "Don't you dare faint." Both women turned red, the older woman from anger and Ritter from embarrassment, but this return of blood to their heads "saved the situation." As Ritter wrote, "The two women students did not faint and thus disgrace the sex. That three men did faint was merely due to a passing circulatory disturbance of no significance; but had the two women medical students fainted, it would have been incontrovertible evidence of the unfitness of the entire sex for the medical profession."
Ritter also recalled that women were treated differently than men at graduation time and were urged not to attend the celebration banquet. Believing it their duty to warn the ladies, their male classmates advised them that there would be much "drinking and lewd story telling" and that "some members of both class and faculty would be under the table before the dinner was over." Thus, while the women were able to attend the graduation exercises and receive their diplomas, they were absent from the banquet afterward.
In the late 1800s, requirements for graduation at Cooper Medical College were quite different from the present day. The first rule was not strictly academic, but required that the "candidate must be of good moral character, and at least twenty-one years of age." Other conditions included pre-clinical lecture attendance, clinical instruction, exams and the dissection of at least one entire cadaver. Total fees at the time were $145 for the first year, $130 for the second and third years, and only $40 for the graduating year. There were both "short" and "regular" courses of study, with the former running from February 1 to April 30 and the latter June 1 to November 30. The most interesting prerequisite, however, was the requirement of a "Medical Thesis" based upon cases the student had actually observed and studied at the College and Hospital Clinics. The dissertation subjects chosen by the female medical graduates revealed a strong leaning toward the care of women and children.
FOR EXAMPLE, IN 1897 CAROLINE LOUISE AVERY HANDWROTE HER THESIS ON "THE TRANSITION FROM GIRLHOOD TO WOMANHOOD," IN WHICH SHE ADDRESSED THE AILMENTS OF PUBERTY (AGES 10 TO 16) FOR THE MAKING OF BETTER MOTHERS. Making a medical argument against what she considered to be the unhealthy dress for women at the time, Avery lambasted corsets, "French-heeled shoes" and heavy unsupported skirts, which she equated to five-pound weights that "shock[ed]" the abdomen and hips at every step. Another student in the same year, Mary Lydia Hastings Arnold, submitted her handwritten dissertation on the "Bacteriological Study of School Utensils," in which she presented detailed drawings of bacteria that she had found on clay, lead pencils and chalk. A meticulous researcher, she hoped to contribute medical knowledge that would prevent the spread of disease among schoolchildren.
Despite the relatively high numbers of female medical students at Cooper Medical College in the late 1800s, these would-be women doctors faced barriers when it came to obtaining clinical experience. Hospitals, ambulances and dissection rooms were not considered places for the "gentler sex." To gain the clinical experience they needed, women physicians traveled to Europe if they had the proper connections. Women also founded their own hospitals, with Elizabeth Blackwell's New York Infirmary for Indigent Women and Children serving as the model. In 1875, three women physicians educated on the East Coast, Charlotte Blake Brown, Martha Bucknall and Sara E. Browne, came to San Francisco and opened the Pacific Dispensary for Women and Children, which over the years provided opportunities for female physicians to obtain internship experience. In 1876, the three women were also gained membership in the California State Medical Society with immediate appointments to special committees on diseases of women and children.
The trend toward female medical students continued throughout the early 1900s, correlating with a national movement for female suffrage and women's rights. In 1908, Stanford University bought Cooper Medical College, and by 1914 four out of the twelve members (33 percent) in the Stanford medical school graduating class were women. Many of the women were over the age of 30; they were considered rather old for medical students. As such, they received less advantageous treatment than did the younger women. In her memoir Yesterday, Cooper Medical College student Grace S. Thille recalled how some male students and instructors were "not very cordial to the older women students." For example, one student in her thirties was told that "she would be just as useful out in the cemetery as she would be in an operating room." The doctor then went on to say, "The baby instructions you would need to do any operation you would not find in any text book!" Thille herself was fortunate enough to gain experience during vacations at a county hospital in Santa Clara Valley, where a good-natured doctor took her under his wing and put her to work as his scrub nurse.
By the 1930s, however, the waning of the Progressive Era and the arrival of the Depression coincided with a decrease in the enrollment of women at Stanford's medical school. By 1937, only 11 women (5 percent) were enrolled out of a total of 238 students in all four classes. Throughout the 1940s and 1950s, female enrollment continued to be low, ranging between 5 and 10 percent of the total medical school class. It was not until the 1960s and 1970s that the percentage of women medical students at Stanford again reached the levels that had prevailed in the 1880s and 1890s at Cooper Medical College.
By 1968, there were nine women in the first-year class at Stanford University School of Medicine, and together they made up 12 percent of their medical school class. In an article titled "Stanford's Young Women in Medicine," published in the 1968 Winter issue of Stanford MD, the editors mistakenly believed this figure to be the "highest percentage in Medical School history" -- which was not quite true, given that 33 percent of the Stanford medical school class of 1914 was female. Interviews revealed the students to be of varied educational background, with undergraduate majors ranging from Renaissance and Reformation history to English literature to philosophy, the classics and archaeology. Spending their free time in activities such as modern dance, tutoring minority children in an East Palo Alto high school and training an Arabian horse, the women also had diverse extracurricular interests. Hoping to gain insight into the status of women at Stanford University School of Medicine, the editors of Stanford MD posed the following questions to the female students: What was your motivation for entering medicine? Why did Stanford attract you and how are you accepted by your male counterparts? Can a woman in medicine handle the triple role of doctor, wife and mother?
The women responded thoughtfully and with candor. For the most part, they cited the strong influence of scientifically inclined brothers or family members in medicine leading them to the healer's path. Differentiating Stanford from other medical schools, all denied feeling discrimination against women and cited the flexible, low-pressure, five-year option as a strong attraction. One woman specifically stated, "Stanford was the only medical school to which I applied where I did not feel the admissions committee was very unhappy about admitting a married woman, particularly one with a child." Among the unmarried women, however, there was less certainty about the choice between career and family. A few of the women stated outright that if they were forced to choose between medicine and family life, they would give up their professional practices.
Women's issues were drawing increasing attention not just at Stanford but throughout the nation. In July 1968, the Josiah Macy Jr. Foundation awarded Stanford University School of Medicine a grant to establish a program to study the problems unique to women pursuing a medical career. The program included counseling and financial aid at all career levels, arranging flexible scheduling for incoming women interns, organizing experimental small sensitivity training groups for women, and compiling statistics on women physicians associated with Stanford.
The following year, a pivotal event focused attention on educating women at Stanford University School of Medicine. In February 1969 the university received a bequest of $5 million from the estate of Mrs. Katharine Dexter McCormick to be "used for the benefit of the Stanford School of Medicine." More specifically, McCormick had requested that the funds be reserved "in aid of women students attending the School of Medicine and more generally for the encouragement and assistance of women in pursuing the study of medicine, in teaching medicine and in engaging in medical research."
The McCormick Fund became a catalyst for organizing women at Stanford University School of Medicine. In 1969, the Faculty Senate of the medical school voted unanimously to form a standing committee charged with increasing the number of women in the medical school and promoting the careers of women at Stanford. On March 12, 1970, Barbara Carroll, a third-year medical student, was elected by the Stanford Medical Student Association (SMSA) as a delegate to the newly formed Joint Committee on the Status and Tenure of Women. In an effort to recruit more female medical students, the admissions committee published a pamphlet titled "Women in Medicine," which was sent to all undergraduate medical advisory committees across the country. At the time of publication, female candidates comprised 10 percent of the applicant pool and about 10 percent of the students offered places each year were women -- giving female applicants the same theoretical chance for acceptance as their male counterparts.
BY JULY 1, 1971, THE STANFORD UNIVERSITY SCHOOL OF MEDICINE NEWS BUREAU WAS ABLE TO ISSUE A PRESS RELEASE STATING THAT 21 PERCENT OF ITS 77-MEMBER ENTERING CLASS WOULD BE FEMALE -- NEARLY DOUBLE THE NUMBER OF WOMEN ADMITTED IN PREVIOUS YEARS. Crediting the change to a new program adopted by the Faculty Senate that called for a substantial increase in the proportion of women on the faculty, house staff and student body, Dr. John P. Bunker and Dr. Judith Pool -- chairman and member of the medical school's Joint Committee on the Status and Tenure of Women respectively -- wrote a guest editorial in the July 1, 1971, issue of the New England Journal of Medicine.
"The potential pool of professional women is large and almost untapped," he wrote. With encouragement, it should be possible to increase the number of women applicants to nearly equal that of men, he added. "We must make sure that young women know that the gates of the medical schools are open to them, and we must assure them that becoming a physician is an appropriate and realistic goal." The editorial called for similar action on the part of other medical schools to encourage women who may be interested in but are hesitant about a medical career. The actions advised included improved recruitment programs and close contacts with parents, teachers and vocational counselors who could aid in guiding young women in their choice of careers. "We still have a long way to go," wrote Pool, "but first we want young women to know that this is the new look -- and that all the negativism about medicine careers for women is out of date."
Yet by June 1973, despite the optimism, men still outnumbered women by four to one in Stanford medical school's student body. This sparked the Joint Committee on the Status and Tenure of Women to take a close look at the school's admission patterns. But after analyzing the relationship between admission and academic fitness, the committee was surprised to find that not only was the Admissions Committee not practicing discrimination against women, it actually appeared to be favoring women by a slight margin.
Then the Joint Committee took its investigation one step further and analyzed the effect that increasing the number of admitted women would have on the average GPA and MCAT scores of the class. Using data from the applicants to the class admitted in fall 1973, the study experimentally substituted unaccepted females for accepted males. The male and female interviewed applicants were ordered according to their GPA/MCAT scores, using a multiple logistic approach. The unaccepted female with the highest score was then substituted for the accepted male with the lowest score, retaining a total of 226 accepted candidates (the actual number accepted for that class). This procedure was repeated until the whole group of 226 was females. The study revealed that academic qualification improved with increasing proportion of females and that the optimum class, in terms of academic fitness, would contain about 50 percent women.
As a result, in 1974 the Joint Committee on the Status and Tenure of Women recommended that admissions to new medical school classes be 50 percent men and 50 percent women. The Committee made the argument that the study had demonstrated that equalizing the number of women and men would not result in any perceptible lowering in the standards of Stanford University School of Medicine, since the pool of superior applicants was so large.
In actuality, it was not until the 1990s that the numbers of female and male medical students matriculating at Stanford medical school truly began to reach parity. In 1995, 42 percent of Stanford's medical students were women. In 1997, more than a century after the first woman entered the school that later became Stanford University School of Medicine, the once-unimaginable occurred: Female medical students actually outnumbered male medical students for the first time in the history of Stanford University School of Medicine.
Higgins' legacy has extended to the 21st century as future female and male physicians work side by side, learning how to heal the sick together. What seems so natural to us today would surely surprise her and other pioneering women in medicine -- pleasantly, I hope. SM