By Lucy D. Ozarin, M.D.

Women have been healers and caretakers of the sick since ancient times, but official recognition of women in these roles did not occur in the United States until the mid-19th century.

While serving an apprenticeship had been the traditional route to the practice of medicine, medical schools had already been established by the early 1800's. In 1847 Harriet Hunter of Boston, having served an apprenticeship, applied for admission to Harvard Medical School in 1847 and again in 1850. She was rejected on the basis of gender. Harvard Medical School did not admit women until 1945.

Elizabeth Blackwell was the first American woman to be admitted to a medical school, graduating from Geneva Medical College in New York in 1849. Her sister followed in 1854. They became ardent advocates for medical training for women, and several medical schools for women were established. The Woman's Medical College in Philadelphia was founded in 1848, becoming the Medical College of Pennsylvania in the mid-20th century. It has now merged with Hahnemann Medical School.

Mental hospitals were established in the United States after 1772, when a hospital in Williamsburg, Va., was established. First called the Public Hospital, it was renamed the Eastern Lunatic Asylum in 1841 and Eastern State Hospital at the turn of the century. The hospital was sparsely used for many years, admitting only 36 patients in its first six years.

When mental hospitals became larger, physicians other than the physician superintendent were needed, and the post of assistant physician was created. Women were entering the ranks of physicians, although negative attitudes toward hiring women physicians persisted.

In 1869 Worcester State Hospital in Massachusetts hired Dr. Mary Stinson, and hospitals in Iowa, Michigan, and other states followed suit. In Pennsylvania Dr. Hiram Corson, a general practitioner, began a campaign in 1876 to require mental hospitals to hire women physicians. With the strong support of women's groups, the law was passed despite the strong opposition of the grand old man of the Association of Medical Superintendents of American Institutions for the Insane, the forerunner of the American Psychiatric Association, Dr. Thomas Kirkbride of the Pennsylvania Hospital, as well as Dr. Thomas Curwen, superintendent of the Harrisburg (Pa.) State Hospital, and the opinionated Dr. John Gray of the Utica (N.Y.) State Hospital. Dr. Curwen was secretary of the association for 34 years. Dr. Gray was editor of the American Journal of Insanity, the predecessor of the American Journal of Psychiatry, for 30 years.

The opposition to women physicians remained strong until the turn of the century. Dr. John Chapin, superintendent of the Willard State Hospital in New York, went so far as to resign his position when his Board of Trustees appointed a woman physician to the staff in 1884. Dr. Chapin moved to the Pennsylvania Hospital, where no woman physician was hired until he retired in 1912.

In a paper read to the Chicago Medical Society in 1886, Dr. Paoli Kiernan quoted those who believed it would be disadvantageous to use women physicians because they are "desirous of unsexing themselves and apt to gossip and become capricious and insubordinate to the superintendent."

At an annual meeting of the Association of Medical Superintendents of American Institutions for the Insane, Dr. Chapin reported he had received a letter from a fellow superintendent complaining that his female assistant physician had disgusted everybody by her desire to examine all her patients. At Willard State Hospital, the superintendent, required by law to hire women physicians, hired one. He paid her $600 a year, plus room and board, while male physicians were receiving $2,000 a year. However, Dr. Weir Mitchell, in his famous diatribe against psychiatry at the 1894 annual meeting of the association, spoke up for women physicians, saying, "On the female side, it is a woman helped by women."

In a survey in 1900 Dr. Calista Luther, a psychiatrist, found that of 13 mental hospitals, 38 employed women physicians. The women did not stay long because professional advancement was blocked, salaries were often lower than those of men, and women were denied authority. Many left to enter private practice. Publications by women began to appear, several in 1893 in the Journal of Nervous and Mental Diseases. The American Journal of Insanity in 1895 published "Gynecological Disorder, the Relation to Insanity," by Dr. Clara Barrus of the Middleton State Hospital in New York.

After the turn of the century, fewer women entered medicine, but after World War II, their numbers burgeoned. Now 40 percent of the students admitted to medical school are women, and 40 percent of psychiatry residents are women. Three APA presidents have been women (Drs. Carol Nadelson, Elissa Benedek, and Mary Jane England). The next hurdle is having more women psychiatrists hold leadership positions.

(Psychiatric News, April 18, 1997)