Women in medicine

Historically and in many parts of the world, women's participation in the profession of medicine (as physicians, for instance) has been significantly restricted, although women's practice of medicine, informally, in the role of caregivers, or in the allied health professions, has been widespread. Most countries of the world now provide women with equal access to medical education. However not all countries ensure equal employment opportunities and gender equality has yet to be achieved within the medical specialties and around the world.

Modern medicine

Wafaa El-Sadr is an Egyptian epidemiologist and MacArthur Fellow who directs two programmes at Columbia University's Mailman School of Public Health.

Monique Frize (centre) is a Canadian academic and biomedical engineer known for her expertise in medical instrumentation and decision support systems (DSS).

Awa Marie Coll Seck is Senegal's former Minister of Health and an international public health expert, Executive Director of the Joint United Nations Programme on HIV/AIDS and the Roll Back Malaria (RBM) Partnership.

In 1540 Henry VIII granted the charter for the Company of Barber Surgeons; women were barred. Women did, however, continue to practise during this time. They continued to practise without formal training or recognition in England and eventually North America for the next several centuries. Women's participation in the medical professions was generally limited by law and practice during the decades while medicine was professionalizing. However, women openly practicing medicine in the allied health fields (nursing, midwifery, etc.), and throughout the nineteenth and twentieth centuries, women made significant gains in access to medical education and medical work through much of the world. These gains were sometimes tempered by setbacks; for instance, Mary Roth Walsh documented a decline in women physicians in the US in the first half of the twentieth century, such that there were fewer women physicians in 1950 than there were in 1900. However, through the latter half of the twentieth century, women had gains generally across the board. In the United States, for instance, women were 9% of total US medical school enrollment in 1969; this had increased to 20% in 1976. By 1985, women comprised 14% of practicing US physicians.

At the beginning of the twenty-first century in industrialized nations, women have made significant gains, but have yet to achieve parity throughout the medical profession. Women have achieved parity in medical school in some industrialized countries, since 2003 forming the majority of the United States medical student body. In 2007-2008, women accounted for 49% of medical school applicants and 48.3% of those accepted. According to the American Association of Medical Colleges (AAMC) 48.3% (16,838) of medical degrees awarded in the US in 2009-10 were earned by women, an increase from 26.8% in 1982-3.

However, the practice of medicine remains disproportionately male overall. In industrialized nations, the recent parity in gender of medical students has not yet trickled into parity in practice. In many developing nations, neither medical school nor practice approach gender parity.

Moreover, there are skews within the medical profession: some medical specialties, such as surgery, are significantly male-dominated, while other specialties are significantly female-dominated, or are becoming so. In the United States, female physicians outnumber male physicians in pediatrics and female residents outnumber male residents in family medicine, obstetrics and gynecology, pathology, and psychiatry.

Women continue to dominate in nursing. In 2000, 94.6% of registered nurses in the United States were women. In health care professions as a whole in the US, women numbered approximately 14.8 million, as of 2011.

Biomedical research and academic medical professions—i.e., faculty at medical schools—are also disproportionately male. Research on this issue, called the "leaky pipeline" by the National Institutes of Health and other researchers, shows that while women have achieved parity with men in entering graduate school, a variety of discrimination causes them to drop out at each stage in the academic pipeline: graduate school, postdoc, faculty positions, achieving tenure; and, ultimately, in receiving recognition for groundbreaking work. (See women in science for a broader discussion.)

History

Hildegard of Bingen, a Medieval German abbess who wrote Causae et Curae, a medical text.

Russian Empress Alexandra Feodorovna with Vera Gedroitz, 1915

Elizabeth Blackwell, MD, the first woman to graduate from medical school in the United States (1849).

Woman's Medical College of Pennsylvania in 1886: Anandibai Joshee from India (left) with Kei Okami from Japan (center) and Sabat Islambooly from Syria (right). All three completed their medical studies and each of them was the first woman from their respective countries, obtaining a degree in Western medicine.

Ancient medicine

The involvement of women in the field of medicine has been recorded in several early civilizations. An Egyptian, Merit Ptah (2700 BC), described in an inscription as "chief physician", is the earliest woman named in the history of science. Agamede was cited by Homer as a healer in Greece before the Trojan War. Agnodike was the first female physician to practice legally in 4th century BC Athens. Metrodora was a physician and generally regarded as the first medical writer.

Medieval Europe

During the Middle Ages, convents were an important place of education for women, and some of these communities provided opportunities for women to contribute to scholarly research. An example is the German abbess Hildegard of Bingen, whose prolific writings include treatments of various scientific subjects, including medicine, botany and natural history (c.1151-58). She is considered Germany's first female physician.

The southern Italian coastal town of Salerno was an important center of medical learning and practice in the 12th century. There, the physician Trota of Salerno gathered a number of her medical practices in several written collections. One work on women's medicine that was associated with her, the De curis mulierum ("On Treatments for Women") formed the core of what came to be known as the Trotula ensemble, a compendium of three texts that circulated throughout medieval Europe. Trota herself gained a reputation that spread as far as France and England. There are also references in the writings of other Salernitan physicians to the mulieres Salernitane ("Salernitan women"), which give some idea of local empirical practices.

Dorotea Bucca was another distinguished Italian physician. She held a chair of philosophy and medicine at the University of Bologna for over forty years from 1390. Other Italian women whose contributions in medicine have been recorded include Abella, Jacobina Félicie, Alessandra Giliani, Rebecca de Guarna, Margarita, Mercuriade (14th century), Constance Calenda, Calrice di Durisio (15th century), Constanza, Maria Incarnata and Thomasia de Mattio.

For the medieval Islamic world, little specific is known about female medical practitioners although it is likely that women were regularly involved in medical practice in some capacity. Male medical writers refer to the presence of female practitioners (singular, tabība) in describing certain procedures or situations. For example, the late 10th/early 11th century Andalusi physician and surgeon Abu al-Qasim Khalaf ibn al-Abbas Al-Zahrawi, in explaining how to excise bladder stones, notes that the procedure is difficult for male doctors practicing on female patients: because of the need to touch the genitalia, the male practitioner must either find a woman doctor who can perform the procedure, or a eunuch physician, or a midwife who takes instruction from the male surgeon. In other words, even though direct evidence for female practitioners is rare, their existence can be inferred. As al-Zahrawi's example also suggests, midwives played an important role in the delivery of women's healthcare. For these practitioners, there is more detailed information, both in terms of the prestige of their craft (Ibn Khaldun calls it a noble craft, "something necessary in civilization") and in terms of biographical information on historic women. To date, no known medical treatise written by a woman in the medieval Islamic world has been identified.

Western medicine in China

Traditional Chinese Medicine that is based on the use of herbal medicine, acupuncture, massage and other forms of therapy has been practiced in China for thousands of years. However, Western Medicine was introduced to China in the 19th Century, mainly by medical missionaries sent from various Christian mission organizations, such as the London Missionary Society (Britain), the Methodist Church (Britain) and the Presbyterian Church (US). Benjamin Hobson (1816-1873), a medical missionary sent by the London Missionary Society in 1839, set up a highly successful Wai Ai Clinic (惠愛醫館) in Guangzhou, China. The Hong Kong College of Medicine for Chinese (香港華人西醫書院) was founded in 1887 by the London Missionary Society, with its first graduate (in 1892) being Sun Yat-sen (孫中山). Sun later led the 1911 Xinhai Revolution (Chinese Revolution (1911)), which changed China from an empire to a republic. The Hong Kong College of Medicine for Chinese was the forerunner of the School of Medicine of the University of Hong Kong, which started in 1911.

Due to the social custom that men and women should not be near to one another, the women of China were reluctant to be treated by male doctors of Western medicine. This resulted in a tremendous need for female doctors of Western Medicine in China. Thus, female medical missionary Dr. Mary H. Fulton (1854-1927) was sent by the Foreign Missions Board of the Presbyterian Church (USA) to found the first medical college for women in China. Known as the Hackett Medical College for Women (夏葛女子醫學院), this College was located in Guangzhou, China, and was enabled by a large donation from Mr. Edward A.K. Hackett (1851-1916) of Indiana, US. The College was dedicated in 1902 and offered a four-year curriculum. By 1915, there were more than 60 students, mostly in residence. Most students became Christians, due to the influence of Dr. Fulton. The College was officially recognized, with its diplomas marked with the official stamp of the Guangdong provincial government. The College was aimed at the spreading of Christianity and modern medicine and the elevation of Chinese women's social status. The David Gregg Hospital for Women and Children (also known as Yuji Hospital 柔濟醫院) was affiliated with this College. The graduates of this College included CHAU Lee-sun (周理信, 1890-1979) and WONG Yuen-hing (黃婉卿), both of whom graduated in the late 1910s and then practiced medicine in the hospitals in Guangdong province.

Historic women's medical schools

When women were routinely forbidden from medical school, they sought to form their own medical schools.

• Women's Medical College of Pennsylvania (MCP; founded 1850 as Female Medical College of Pennsylvania)
• London School of Medicine for Women (founded 1874 by Sophia Jex-Blake)
• Edinburgh School of Medicine for Women (founded 1886 by Sophia Jex-Blake)
• Saint Petersburg State Medical University (founded 1897 as Female Medical University)
• Tokyo Women's Medical University (founded 1900 by Yoshioka Yayoi)
• Hackett Medical College for Women, Guangzhou, China, founded in 1902 by Presbyterian Church (USA).

Historic hospitals with significant female involvement

• Woman's Hospital of Philadelphia, founded in 1861, provided clinical experience for Woman's Medical College of Pennsylvania students
• New England Hospital for Women and Children (now called Dimock Community Health Center), founded in 1862 by women doctors "for the exclusive use of women and children"
• New Hospital for Women (founded in the 1870s by Elizabeth Garrett Anderson and run largely by women, for women)
• South London Hospital for Women and Children (founded 1912 by Eleanor Davies-Colley and Maud Chadburn; closed 1984; employed an all-woman staff)

Pioneers

• Merit Ptah (2700 BC), earliest cited women physician
• Agamede, pre-Trojan War healer
• Agnodike was the first female physician to practice legally in 4th century BC Athens.
• Trota of Salerno 12th century physician who collected many of her empirical practices in writing. Part of her work was incorporated into the so-called Trotula compendium of writings on women's medicine and cosmetics.
• Hildegard of Bingen (1098–1179) is considered Germany's first female physician. She conducted and published comprehensive studies of medicine and natural science.
• Patience Miller (1623-1716), appears in records as the only physician and surgeon in Northfield, Connecticut. She is named in "The History of Northfield for 150 years", by Josiah Howard Temple and George Sheldon, Albany, New York, 1875: Page 68 - William Miller was at Ipswich in 1648; was a first settler at Northampton; a tanner by trade. His wife ... Mrs. M. was a skilful physician and surgeon, ... and the only doctor at Northfield during the first two settlements. Patience was born in Ipswich, England and died in Northampton, Connecticut 29 Novrmber 1716. She was the daughter of William Bacon (1593-1653) and his wife, Martha née Worcester ( -1666).
• Dorothea Erxleben (1715–1762), the first female doctor granted a M.D. in Germany.
• James Miranda Barry (179?-1865), a renowned woman doctor who passed as a man to gain a medical education and practice medicine.
• Lovisa Årberg (1801–1881), first woman doctor and surgeon in Sweden.
• Amalia Assur (1803–1889), first woman dentist in Sweden and possibly Europe.
• Ann Preston, (1813–1872), first female dean of any medical school.
• Elizabeth Blackwell (1821–1910), first woman to graduate from medical school in the US; MD 1849, Geneva College, New York.
• Rebecca Lee Crumpler, (8 February 1831 – 9 March 1895), first African American woman physician in the United States, awarded her M.D. in 1864 by Boston University.
• Lucy Hobbs Taylor (1833–1910), the first woman dentist in the United States.
• Elizabeth Garrett Anderson (1836–1917), pioneering woman doctor and feminist in Britain; co-founder of London School of Medicine for Women.
• Madeleine Brès (1839–1925), the first French female MD
• Sophia Jex-Blake (1840-1912), English physician, feminist and teacher.
• Nadezhda Suslova (1843–1918), the first Russian female MD, a graduate of Zurich University
• Frances Hoggan (1843–1927), first British woman to receive a doctorate in medicine (1870).
• Edith Pechey-Phipson (1845–1908), pioneering English doctor in the India; MD 1877, University of Bern and Licentiate in Midwifery, 1877 Royal College of Physicians of Ireland.
• Mary Scharlieb (1845-1930), pioneer British female physician.
• Margaret Cleaves (1848–1917), pioneering doctor in the brachytherapy; M.D. 1873.
• Ernestina Paper (?), first Italian woman to receive an advanced degree (in medicine), 1877.
• Dolors Aleu i Riera (1857–1913), first female medical doctor from Spain, 1879.
• Ogino Ginko (1851-1913), first licensed and practicing woman physician of western medicine in Japan.
• Aletta Jacobs (1854-1929), first woman to complete a university course in the Netherlands, and the first Dutch female MD.
• Hope Bridges Adams Lehmann (1855-1916), first female general practitioner and gynecologist in Munich, Germany.
• Ana Galvis Hotz (1855-1934), first Colombian woman, and from Latin America, to obtain a medical degree.

Maria Cuţarida 1857-1919. Stamp of Romania, 2007.

• Maria Cuțarida-Crătunescu (1857–1919) the first female doctor in Romania
• Kadambini Ganguly (1861–1923), the first Indian woman to obtain a medical degree in India having graduated from the Calcutta Medical College in 1886.
• Annie Lowrie Alexander (1864–1929), first licensed female physician in the Southern United States
• Elsie Inglis (1864–1917) Pioneering Scottish doctor and suffragist, born in India. MD Edinburgh School of Medicine for Women, worked at Rotunda Hospital, Dublin
• Anandi Gopal Joshi (1865-1887), the first Indian woman to obtain a medical degree having graduated from the Woman's Medical College of Pennsylvania in 1886.
• Susan La Flesche Picotte (1865-1915), the first Native American woman to obtain a medical degree.
• Emma K. Willits (1869–1965), believed to be only the third woman to specialize in surgery and the first to head a Department of General Surgery at Children's Hospital in San Francisco, 1921-1934.
• Bertha E. Reynolds (1868-1961), among the first women licensed to practice medicine in Wisconsin, serving the rural communities of Lone Rock and Avoca
• Vera Gedroitz (1870–1932), the first professrix of surgery in the world
• Maria Montessori (1870–1952), one of the first female MDs in Italy; renowned educator
• Florence Sabin (1871-1953), the first woman elected to the US National Academy of Sciences.
• Hannah Myrick (1871–1973), helped to introduce the use of X-rays at the New England Hospital for Women and Children
• Yoshioka Yayoi (1871–1959), one of the first women to gain a medical degree in Japan; founded a medical school for women in 1900.
• Marie Equi (1872–1952), American doctor and activist for women's access to birth control and abortion.
• Laura Esther Rodriguez Dulanto (1872–1919), the first Peruvian woman to have obtained a medical degree.
• Muthulakshmi Reddi (1886–1968), one of the early female medical doctors in India and a major social reformer.
• Matilde Hidalgo (1889–1974), the first Ecuadorian woman to have obtained a medical degree.
• Chau Lee-sun (1890-1979), first Chinese woman to have obtained a medical degree.
• Safieh Ali (1900-?), first Turkish woman to have obtained a medical degree.
• Virginia Apgar (1909–1974), significant work in anesthesiology and teratology; founded field of neonatology; first woman granted full professorship at Columbia University College of Physicians & Surgeons.
• Badri Teymourtash (1911–1989) is the first Iranian female medical doctor, educated in USA and Belgium.
• Kathryn Stephenson (1912-1993), first American woman board-certified as a plastic surgeon
• Margaret Allen, first female heart transplant surgeon in the USA - transplant performed in 1985
• Jane Elizabeth Hodgson (1915–2006), pioneering provider of reproductive healthcare for women and advocate for women's rights.
• Barbara Ross-Lee (b. 1942), first African American woman dean of a U.S. medical school (1993), Ohio University College of Osteopathic Medicine.
• Nancy Dickey, first woman president of the American Medical Association
• Nancy C. Andrews (b. 1958), first woman Dean of a top ten medical school in the United States (2007), Duke University School of Medicine.

Women's health movement in the seventies

The seventies marked a great increase of women entering and graduating from medical school. From 1930 to 1970, a period of 40 years, about 14,000 women graduated from medical school. From 1970 to 1980, a period of 10 years, over 20,000 women graduated from medical school. This increase of women in the medical field was due to both political and cultural changes.

Two laws in the United States lifted restrictions for women in the medical field -- Title IX of the Higher Education Act Amendments of 1972 and the Public Health Service Act of 1975, banning discrimination on grounds of gender. In November 1970, the Assembly of the Association of American Medical Colleges rallied for equal rights in the medical field.

At the same time, women's ideas about themselves and their relation to the medical field were shifting due to the women's movement.

A sharp increase of women in the medical field led to developments in doctor patient relationships, changes in terminology and theory. One area of medical practice that was challenged and changed was gynecology. Wendy Kline talks about the blurring of “clinical” and “sexual” that occurred in the medical field in the late 40s into the 60s, particularly in gynecology. Kline says that “to ensure that young brides were ready for the wedding night, they [doctors] used the pelvic exam as a form of sex instruction .” In Ellen Frankfort’s book Vaginal Politics, Frankfort talks about the “shame” and “humiliation” felt during a pap test; “I was naked, he was dressed; I was lying down, he was standing up; I was quiet, he was giving orders ”

With higher numbers of women enrolled in medical school medical practices, like gynecology were challenged and changed. One medical student is quoted in Kline’s book as saying, “Since I experienced my own exams as a humiliating procedure, I feared inflicting the same humiliation on another person. ” In 1972 the University of Iowa Medical School, was one school that instituted a new training program for pelvic and breast examinations. Students would act both as the doctor and the patient, allowing each student to understand the procedure, and create a more gentle, respectful, examination. This method was quite different from the previous practice in which doctors were taught to assert their power over patients. With changes in ideologies and practices, throughout the 70s, by 1980 over 75 schools had adopted this new method.

With women entering the medical field and women’s rights movements came also the women’s health movement which sought alternative methods of health care for women. This came through the creation of self-help books, most notably Our Bodies, Ourselves: A Book by and for Women. This book gave women a “manual” to help understand their body. It challenged hospital treatment, and doctor’s practices. Aside from self-help books, many help centres were opened: birth centres run by midwives, safe-abortion centres, and classes for educating women on their bodies; all with the aim of providing non-judgmental, warm, and comfortable care for women. Kline speaks to this claim women were taking on their body in relation to the medical world; women felt that “not only should women have access to information about their bodies... they should also help to create this knowledge. ” The women’s health movement, along with women involved in the medical field opened the doors for research and awareness for female illness like breast cancer and cervical cancer.

The small island nation of Tuvalu in 2008 welcomed its first Tuvaluan female doctors as a result of Australian aid.

While scholars in the history of medicine had developed some study of women in the field—biographies of pioneering women physicians were common prior to the 1960s—the study of women in medicine took particular root with the advent of the women's movement in the 1960s, and in conjunction with the women's health movement. Two publications in 1973 were critical in establishing the women's health movement and scholarship about women in medicine: First, the publication of Our Bodies, Ourselves in 1973 by the Boston Women's Health Collective, and second, "Witches, Midwives, and Nurses: A History of Female Healers", a short paper by Barbara Ehrenreich and Deirdre English also in 1973. The Ehrenreich/English paper examined the history of women in medicine as the professionalization of the field excluded women, particularly midwives, from the practice. Ehrenreich and English later expanded the work into a full-length book, For Her Own Good, which connected the exclusion of women from the practice of medicine to sexist medical practices; this text and Our Bodies, Ourselves became key texts in the women's health movement. The English/Ehrenreich text laid out some early insights about the professionalization of medicine and the exclusion of women from the profession, and numerous scholars, such as Diana Elizabeth Long, have greatly built upon and expanded this work.

See also

• American Medical Women's Association
• History of medicine
• History of nursing
• Category:Midwives

Biographies

• Laurel Thatcher Ulrich, A Midwife's Tale: The Life of Martha Ballard Based on Her Diary, 1785-1812 (1991)
• Rebecca Wojahn, Dr. Kate: Angel on Snowshoes (1956)

Bibliography

• Abram, Ruth Abram.], Send Us a Lady Physician: Women Doctors in America, 1835-1920
• Benton J.F., "Trotula, women's problems, and the professionalization of medicine in the Middle Ages", Bulletin of Historical Medicine v. 59, n.1, pp. 30–53 (Spring 1985).
• Blake, Catriona. The Charge of the Parasols: Women's Entry to the Medical Profession
• Borst, Charlotte G. Catching Babies: Professionalization of Childbirth, 1870-1920 (1995), Cambridge, MA: Harvard University Press
• Elisabeth Brooke, Women Healers: Portraits of Herbalists, Physicians, and Midwives (biographical encyclopedia)
• Chenevert, Melodie. STAT: Special Techniques in Assertiveness Training for Women in the Health Profession
• Barbara Ehrenreich and Deirdre English, Witches, Midwives, and Nurses: A History of Women Healers
• Deirdre English and Barbara Ehrenreich, For Her Own Good (gendering of history of midwifery and professionalization of medicine)
• Julie Fette, "Pride and Prejudice in the Professions: Women Doctors and Lawyers in Third Republic France," Journal of Women's History, v.19, no.3, pp. 60–86 (2007). France, 1870–1940
• Grant, Susan-Mary. "On the Field of Mercy: Women Medical Volunteers from the Civil War to the First World War." American Nineteenth Century History (2012) 13#2 pp: 276-278. on USA
• Henderson, Metta Lou. American Women Pharmacists: Contributions to the Profession
• Junod, Suzanne White and Seaman, Barbara, eds. Voices of the Women’s Health Movement, Volume OneSeven Stories Press. New York. 2012. Pgs 60-62.
• Leneman, Leah. "Medical women at war, 1914–1918." Medical history (1994) 38#2 pp: 160-177. online
• Luchetti, Cathy. Medicine Women: The Story of Early-American Women Doctors. New York: Crown,
• Regina Morantz-Sanchez, Sympathy and Science: Women Physicians in American Medicine (1985 first ed.; 2001)
• More, Ellen S. Restoring the Balance: Women Physicians and the Profession of Medicine, 1850-1995
• Perrone, Bobette H. et al. Medicine Women, Curanderas, and Women Doctors (1993); cross-cultural anthropological survey of traditional societies
• Pringle, Rosemary. Sex and Medicine: Gender, Power and Authority in the Medical Profession
• Schwirian, Patricia M. Professionalization of Nursing: Current Issues and Trends (1998), Philadelphia: Lippencott, ISBN 0-7817-1045-6
• Walsh, Mary Roth. Doctors Wanted: No Women Need Apply: Sexual Barriers in the Medical Profession, 1835-1975 (1977)

External links

• The Archives for Women in Medicine, Countway Library, Harvard Medical School
• "Changing the Face of Medicine", 2003 Exhibition at the National Library of Medicine;"NLM Exhibit Honors Outstanding Women", NIH Record, Nov. 11, 2003. exhibition website at http://www.nlm.nih.gov/changingthefaceofmedicine .
• History of Manitoba Women in Health - includes brief biographies of the following: Dr. Charlotte Whitehead Ross, Dr. Amelia Yeomans, Dr. Elizabeth Beckett Matheson, Dr. Margaret Ellen Douglass, Dr. Frances Gertrude McGill, Dr. Elinor Frances Elizabeth Black, Dr. Gerda Allison, Phyllis Jean McAlpine, PhD, F.C.C.C.G, The Grey Nuns, Margaret Scott, Anne G. Ross, Mary Speechly, Dr. Helen Glass, Grace Easter
• Women Physicians: 1850s-1970s - online exhibit at the Drexel University College of Medicine Archives and Special Collections on Women in Medicine and Homeopathy
• "The Stethoscope Sorority", an online exhibit from the Archives for Women in Medicine