By: Nina Rodwin

Originally published by the Center for the History of Medicine on December 5, 2017: https://cms.www.countway.harvard.edu/wp/?p=14583

Nina Rodwin, UMass Boston Public History Student

When I started my internship at Harvard’s Countway Library of Medicine, my project adviser, Joan Ilacqua, project archivist for the Archives for Women in Medicine, and I decided to investigate digitized journals between 1900 and 1920 from the Medical Heritage Library’s State Medical Society Journals project to uncover the effects of the 1910 Flexner Report on women’s medical education. The goal of the project was to create a digital exhibit about the state of medical education before and after the Flexner Report to better understand how women medical students and physicians were influenced by Flexner’s recommendations. However, as I conducted my research, I found that this topic connected to multiple issues beyond the question of women’s education in the medical field. These new avenues opened the exhibit to larger questions regarding sex, class, gender, and race during the early 20^th century.

Abraham Flexner, c.a. 1908.

In 1908, Professor Abraham Flexner was hired by the Council on Medical Education (a branch of the American Medical Association) to travel to each American medical school and evaluate the overall institution; from  curriculum, to the number of faculty, to the condition of laboratories and libraries. Flexner’s findings were unnerving and the quality of medical schools varied wildly. Flexner recommended that schools with financial means should emulate the quality of education seen at Johns Hopkins University, one of the first medical schools affiliated with a teaching hospital that also required laboratory experience for all its students. Flexner strongly recommended that schools which could not afford such expensive upgrades be closed.

Modern analysis of the Flexner report shows that his decisions meant that most women’s and Black medical schools were closed, as these institutions often had fewer funds. While medical students in the early 20^th century were more likely to learn the latest medical techniques from prestigious institutions, many women and Black medical students were barred from these opportunities, as many schools (including Harvard) openly refused to admit them or admitted them in minuscule numbers. When I began this project, I assumed that these issues would be reflected and discussed in the state medical journals of the time.

I imagined discovering blustering editorials, where the authors would be offended at the very the idea of women entering the medical field. However, I struggled to find any editorial that even mentioned women, yet alone any that excoriated them for being in the field. I found many articles and editorials that dryly reported the progress of medical education and criticized the Flexner Report for its negative conclusions, but none discussed what these changes would mean for women medical students. Finding little evidence connecting the Flexner Report to women’s education in medical schools was particularly important– it demonstrated that many physicians in the early 20^th century were no longer outraged by the idea of women practicing medicine. The research showed that the question for women physicians in the early 20^th century was not a debate surrounding their abilities or rights to practice medicine, but was rather a debate surrounding which kinds of medical fields were best suited for women.

The Woman’s Medical Journal, Vol. XV, No. 4. April 1905.

In fact, women physicians during the early 1900s went to great efforts to prove sex discrimination was a relic of the past. This belief however, was often countered by their own experiences, as seen in editorials from The Woman’s Medical Journal. These editorials were especially interesting when compared with editorials from state medical journals, as both used cultural ideas about women, motherhood, and women’s natural abilities to argue for or against women in certain fields. As my research progressed, I was especially drawn to the differences between the Women’s Medical Journal (WMJ) and the Pennsylvania Medical Journal. (PMJ) While both journals contained medical articles, the WMJ also had a social justice slant, advocating for women’s medical education across the world, endorsing a woman’s right to vote, and demonstrating that women physicians were just as capable as their male counterparts. Both journals portrayed women in the medical field, but PMJ often emphasized traditional ideas about a “women’s place.” For example, there are many articles in the PMJ, including this toast given in 1907, about the self-sacrificing wives of male physicians, but no mention of the struggle women physicians faced balancing their social, professional and domestic roles.

My research found that the fields of anesthesiology and lab work were seen as ideal place for women physicians. Public health was especially popular for women physicians, as its focus

Caption from “The Doctor’s Wife,” a speech given by H.J. Bell, MD in 1907.

on the household, parenting, dieting, and children’s health were considered extensions of a woman’s natural role as caretaker and mother. However, white women physicians in the field of public health in the early 20^th century often advocated for eugenic practices, including limiting marriages to those considered “fit” and the sterilization of those considered “unfit.” So as white women advocated for equality in the medical field, they also encouraged policies that targeted and discriminated women from marginalized groups. While this topic is quite disturbing, I have found this section of my research the most interesting, as the concepts advocating for White Supremacy are very similar both in the early 20^th century and today.

I believe that making historical connections to modern events can be a great tool to help connect today’s audiences to the past. The issue of discrimination against women in the workplace is still very relevant today, especially in the medical field. The decisions made by the Flexner Report still affect medical education today. Although women’s enrollment in medical schools was almost evenly split with men in 2016, according to the Association of American Medical Colleges (AAMC), and rates of minority student enrollment has increased over time, Latino and Black students only comprise 20% of incoming medical students nationwide although these statistics do not break down minority applicants by gender.  Furthermore, women in the workforce still struggle with societal expectations of motherhood and marriage, making the balance between their personal lives and professional lives much harder. Although my research evolved from a project specifically on the Flexner Report to an analysis of women in medicine in the early 20^th century, I hope my forthcoming exhibit can shed light on how far women have come, while reminding my audience that many obstacles remain. I look forward to completing the internship and presenting my findings.