"Woman's Place in Medicine"

“Woman’s Place in Medicine: The Career of Dr. Mary Hancock McLean” by Marion Hunt

The following article is reprinted with permission from the July 1980 issue of The Bulletin of the Missouri Historical Society, vol. 36, no. 4 ©1980 by the Missouri Historical Society.

Woman’s proper place, her appropriate sphere of influence and action, was a major subject of discussion throughout the nineteenth century. In order to gain access to any new activity outside the home, women had to justify it in terms of its relationship to their natural environment: the domestic sphere. Nowhere was this more the case than for women who wanted to enter the medical profession. In order to step outside of their sanctioned place in the home, women who aspired to new voluntary or professional work had to argue that they were merely extending their natural roles as mothers or sisters. In some professions, particularly education and nursing, this position was relatively easy to defend. [1 ] Medicine offered an unusual challenge to women who wanted to move beyond their “proper place” in society. It is, therefore, of special interest to examine the career of Mary Hancock McLean, a pioneer St. Louis physician; this remarkable woman’s life offers an understanding of how a new professional role could be reconciled with nineteenth century ideas of woman’s place. [2 ]

Born in 1861, the daughter of Dr. Elijah McLean, himself a pioneer physician in Washington, Missouri, she was given access to the best education then available for young women. Despite the fact that he was fifty-seven years old when his daughter was born, Dr. McLean was determined that she should have the finest instruction – away from home if necessary. Tutored until she was thirteen, Mary Hancock McLean was sent to Lindenwood College for three years and graduated with the class of 1878. [3 ] She spent two years at Vassar College before entering the Medical Department of the University of Michigan at Ann Arbor from which she graduated in 1883. [4 ]

It is important to understand that women’s access to the new educational opportunities that Mary Hancock McLean enjoyed was a subject of heated debate. Critics of higher education for women argued that such experiences were inappropriate and dangerous. [5 ] The opening of Vassar College in 1865 marked the beginning of women’s access to a curriculum as demanding as that offered at Harvard or Yale. Most female seminaries of the earlier nineteenth century had generally offered courses of study more in keeping with women’s domestic role; at best, their curriculum prepared women for temporary teaching careers rather than the more learned professions.

Women’s education in most public and private institutions conformed to the nineteenth century doctrine of spheres. According to this belief, the maintenance of social and domestic order required that men and women live in – and be educated for – different worlds. While the man’s place was in the world of affairs, the woman’s place was in the home. Her education could only be justified in terms of its beneficial effect on her performance of domestic duties. The opening of Vassar and other new institutions of higher education for women in the late 19th century were a challenge to this dominant view. While most women who attended such schools did, indeed, become wives and mothers, for the first time they had access to an education which afforded them other options. Dr. Mary McLean’s choice of a career as a physician and surgeon would not have been possible earlier in the century. Access to new institutions of higher education with more demanding curricula opened opportunities to enter the professions. Yet for such women, the doctrine of spheres had to be successfully solved; it is significant that they were most successful in gaining access to vocations which conformed with contemporary views of woman’s place.

Medicine offered ambitious and concerned women a special challenge in the late nineteenth century. It gave them an opportunity to connect their interest in health and moral reform with practical action on behalf of women and children – their natural constituency. As Regina Morantz has pointed out, woman’s entrance into the medical profession had its roots in the antebellum health reform movement and was also intimately connected to the broader impetus toward self-determination “in which all reformist women, from conservative social feminists to radical suffrage advocates, played a significant part.” [6 ] Most women physicians were feminists; they believed that their medical skill could and should have a special effect on the lives of women. Since Victorian ideology would not sanction their activity unless it conformed in some way to woman’s place, they argued successfully that their special mission was to serve women and children – a natural extension of their activities in the home. To counter their exclusion from the practice of medicine on protective, moral, and ultimately “natural” grounds, women physicians pressed for their admission to the profession on these same grounds. They argued that as women they could serve female patients with more intuitive understanding and with less violation of their modesty. Serving children’s medical needs was merely an extension of their natural domestic activities.

The success of these arguments lay in their ultimate conformity to the 19th century view of woman’s place. Though barriers to women remained in medical education and practice well into the 20th century, certain specialties serving women and children were considered appropriate for them. To a surprising extent, this legacy remains for women physicians today. [7 ]

Woman’s access to the medical profession was fought on the same grounds as their access to higher education; critics charged that it was both unhealthy and unnatural for them to practice medicine. As a male physician wrote in 1867, “The opposition of medical men (to woman doctors) arises because this movement outrages all their enlightened estimate of what a woman should be. It shocks their refined appreciation of woman to see her follow a profession with repulsive details at every step.” [8 ] It was particularly offensive to consider the possibility of men and women collaborating at the anatomy table. Thus, coeducational medical education was a particularly explosive issue. Even men who supported women’s right to this education questioned the propriety and practicality of mixed classes. Women’s medical education was generally carried on in separate classes or in sexually segregated institutions. [9 ]

The strength and persistence of these attitudes toward women in medicine well into the twentieth century make Mary Hancock McLean’s career especially remarkable. After receiving her medical degree in 1883, Dr. McLean accepted a post as assistant physician at the St. Louis Female Hospital; she was the first woman to hold this post. Her privileged up-bringing and genteel family background could not have prepared her for the experience of treating poor and diseased women, some of whom were prostitutes. However, her deep religious beliefs and humanitarian concerns provide a key for understanding her ability to work in such an institution. The Female Hospital opened in October of 1872 as the House of Industry and was later turned over to the treatment of women’s diseases, many of them venereal in origin. [10 ] During her year as assistant physician, Dr. McLean surely treated many desperate women. This experience left her with a lasting concern for the moral well-being of young girls. Regina Morantz has noted the close connections between women doctors and moral reform:

They concerned themselves with the health problems of women and children because they hoped to raise the moral tone of society through the improvement of family life . . . As science was brought to bear on domestic life, women physicians would become the ‘connecting link’ between the science of the medical profession and the everyday life of women. [11 ]

An examination of Mary Hancock McLean’s later career reveals that she did, indeed, serve as a “connecting link” between medical science and women’s lives.

Despite the many obstacles women physicians encountered in the late nineteenth century, Dr. McLean was fortunate to enter the profession at a time when women in medicine were part of a broad movement rather than isolated figures. When Elizabeth Blackwell became the first American woman to receive a medical diploma in 1849, she was alone in her chosen profession. By the 1880s, there were several hundred women physicians in practice and the women’s medical movement was an accepted, if not sanctioned, phenomenon. [12 ] Confined to certain appropriate specialties, women physicians found their most difficult task was obtaining membership in professional associations and hospital staff positions. The practice of medicine was changing rapidly at this time; as it became more scientific and complex, access to hospitals was particularly important for doctors who wanted to perform surgery. [13 ] It is of special interest to see how Dr. McLean obtained membership in the St. Louis Medical Society and access to local hospitals.

After her appointment at the Female Hospital, Dr. McLean was determined to enter the private practice of obstetrics and gynecology. Her choice of a specialty was in keeping with dominant views about woman’s place in medicine; however, its surgical component made her work a challenge to these ideas. It was this careful balance between conformity to and challenge of woman’s place which characterized her career. In 1885, Dr. McLean became the first woman physician admitted to membership in the St. Louis Medical Society. Her sponsor, the distinguished ophthalmologist Dr. Simon Pollak, recalled the opposition to women physicians in his memoirs:

I was, I believe, the first local practioner to recognize the woman physician in hospital work. I had planned for the recognition of women physicians and was determined that so far as I could I would carry it through. The first who came to my notice was Nancy Levell. She came to St. Louis some time in the 60s, and maintained her profession magnificently. Everybody liked her. She was eminently respectable. She was a Philadelphia (Woman’s Medical College) graduate . . . I brought my protege to the (Mullanphy Hospital) clinic. The other physicians did not like my bringing her there, but I kept her, and she proved a valuable assistant . . . I tried to get her into the St. Louis Medical Society, but did not succeed. Later I succeeded in slipping in Dr. Mary McLean . . . Dr. McLean has become a brilliant practioner, and has done remarkably well . . . [14 ]

Pollak’s account indicates the very real barriers competent women physicians encountered in many cities in the late nineteenth century. Despite his considerable influence and his first protege’s obvious talent and “eminent” respectability, Dr. Pollak was not able to gain admission for Dr. Levell. Just how he was able to “slip” Dr. Mary McLean into the St. Louis Medical Society is not entirely clear from the historical record. Though she was to remain the only woman in the St. Louis Medical Society for fifteen years, Dr. McLean’s admission was an important first step. Her success as a “brilliant practioner” surely helped pave the way for other women to gain this membership. As Martin Kaufman has noted, “By 1880, one can perceive a national trend toward the acceptance of women as members of the medical profession. Yet, the historian should recognize that on the state level, local conditions determined how soon, or how late, they were accepted.” [15 ]

Dr. McLean’s acceptance came one year after the Massachusetts Medical Society admitted women. Surely the support of Dr. Pollak, her excellent medical training, and respectable social position were all factors which influenced the “local conditions” affecting her admission. Yet it is significant that Dr. Pollak himself expressed surprise at her later success:

What is most peculiar is the fact that she has turned out to be more of a surgeon than a physician. Dr. McLean . . . is a lady in the highest sense of the term. She is a benevolent woman . . . after Dr. McLean’s admission to the St. Louis Medical Society I proposed the names of several other women physicians. They were all competent, but none were admitted . . . (Dr. McLean’s) success is chiefly in surgery. She goes to every hospital and reads many valuable papers before the Society . . . [16 ]

Dr. Pollak’s consistent stress on the respectability of the women physicians he sponsored for membership is significant. There was a strong belief, even in the late nineteenth century, that they might be persons of questionable moral character. [17 ] For a woman to practice medicine and retain her respectability was difficult; she had to balance her professional activity with conformity to Victorian ideology. Even Dr. Pollak could not restrain his astonishment at Dr. McLean’s success as a surgeon; surgery was (and remains) an unusual specialty for a woman. Her surgical practice made access to local hospitals a necessity. Though antiseptic conditions could be created in homes, it was a difficult process. Dr. McLean visited numerous offices in St. Louis before she found one which would allow her to hang out her shingle. A colleague, Dr. Frances L. Bishop, herself a graduate of the University of Michigan, remembered Dr. McLean’s account of her first weeks in practice:

It was slow work establishing herself, for there were few women physicians. She has often told, in her racy way, to young women physicians who were soon discouraged at a slow beginning, that for the first three weeks she did not have a one patient. But the tide turned.

Dr. Bishop gave a description of Dr. McLean’s first major operation, performed at home – no doubt before she had access to hospital facilities:

The case was a uterine fibroid, in a colored woman, a former servant, who was finally persuaded to submit to the operation. Dr. McLean spent days sterilizing her own instruments and dressings, and preparing the woman’s house for the operation. She employed two trained nurses. All this at an outlay of some $250, her own expense. The operation was successful, but for some days afterwards Dr. McLean was in a great state of extreme anxiety . . . Tillie lived and recovered a well woman, and Dr. McLean was launched on a surgical career . . . [18 ]

Dr. McLean’s extensive involvement in voluntary benevolence and her wise use of her considerable inheritance were surely helpful in advancing her career and maintaining her professional respectability. Dr. Simon Pollak noted that when her father died, “leaving her a handsome estate . . . she turned it all over to the Bethesda, for the especial care of aged people.” [19 ] This gift certainly helped her gain staff privileges at the Bethesda Hospital which opened in 1889; she was listed as one of its original benefactors and incorporators. Her humanitarian concerns were no doubt sincere; it is important to realize that they had a positive effect on Dr. McLean’s status in the St. Louis community.

After 1900, Dr. McLean’s energy and benevolence were directed toward the plight of young girls who were flocking to St. Louis in ever-increasing numbers. Certainly, this concern was connected with the suffering she had witnessed at the St. Louis Female Hospital in 1884. Her experience in treating venereal diseases led her to a particular interest in young women’s access to decent places of residence. The 1904 World’s Fair was an occasion which brought many inexperienced and unprotected rural women to St. Louis. When they ran out of money or were unable to find employment, they became desperate and vulnerable to exploitation. To help them, Dr. McLean became a sponsor of the Emmaus Home for Girls – a residence organized to care for them until they could find appropriate employment. The Emmaus Home for Girls was the antecedent of the St. Louis YWCA, which was organized in 1905 for the express purpose of fostering the “spiritual, intellectual, social, and physical development of young women.” Dr. McLean served on this organization’s board and was especially involved in its provision of health and hygiene services. An article in the St. Louis Post-Dispatch for September 25, 1911, noted:

The St. Louis YWCA is the first Association in the Country to engage a supervisor for its physical education and hygiene department. . . . There will be classes in gymnasium work, corrective gymnastics under the direction of physicians, folk dancing, club recreation, and walking clubs.

For young women who earned less than five dollars a week for a ten-hour working day, (a common wage in St. Louis and other cities at this time) such activities and services were crucial. Many of them were less than fourteen years of age; according to Miss Gertrude Prack, who worked at the St. Louis YWCA between 1910 and 1920:

“They were undernourished, underpaid, worked long hours, came from poor homes. Dr. McLean saw them with bent shoulders, sunken chests, and felt that the YWCA should put an increasing emphasis on health. Exercises were to be given to help them develop stronger bodies . . . But Dr. McLean knew that all of these girls could not stand strenuous exercises . . . they should not take health education unless first given protective medicals (examinations) . . . Some of the girls had hysterics at the thought of submitting to a medical examination and Dr. McLean came down and talked kindly to those girls, explaining why it was necessary for every girl to have this routine test . . .”

Such medical examinations often uncovered heart conditions, for many youngsters from poor homes had untreated cases of rheumatic fever. According to Miss Prack, Dr. McLean introduced sex hygiene lectures as part of the YWCA health education program. In the early 20th century, this was certainly an innovation. [20 ]

Dr. McLean’s involvement with public health issues and social reform activities was typical of progressive women physicians. This was a natural evolution of their 19th century roots as the “connecting link” between medical science and women’s everyday lives. As twentieth century medicine became less social and more scientific, the special role of women physicians within the profession may well have diminished. [21 ] Missionary and humanitarian work remained common among women physicians who felt a particular obligation to exercise their moral influence in the practice of medicine. Prominent male physicians sanctioned this role well into the twentieth century. Dr. Howard Kelly, a well-known surgeon at Johns Hopkins, and an advocate for women in medicine, wrote in 1937: “There still remain greater conquests for womanhood in the medical-social-moral realm so urgently calling for renovation and purification . . .” [22 ]

In her later career, Dr. McLean extended her activities to include missionary work in China and Japan. Her colleague, Dr. Frances Bishop, described her interest in this region and its people:

She made several trips to China and hoped to locate (there) permanently, but climatic conditions did not warrant this. However, in the months she spent in China she operated in many hospitals in cities where she had medical friends. She was always vitally interested in the education of the Chinese. Some twenty Chinese boys and girls owe their education and especially their medical education to Dr. McLean’s personal and financial support. Many of these during their years in school found a home in her home . . . [23 ]

Throughout her life, Dr. McLean showed a special concern for young women entering the medical profession. Since her own experience had made her aware of the considerable resistance they would inevitably meet, she used her considerable influence to ease their way into the St. Louis medical community. As Dr. Bishop wrote, “She was . . . a true friend to many young women medical students and there is in St. Louis today hardly a woman physician who does not owe in some way her introduction to medical circles to Dr. McLean.” [24 ] Her professional skills and high social standing enabled her to extend woman’s place in medicine far beyond what it had been when she arrived in St. Louis as a young physician in 1884. According to Dr. Ellen Loeffel, “The medical profession not only looked on her as a high type physician and surgeon but demonstrated their feeling by sending to her members of their families and many of their influential friends.” [25 ] Dr. McLean, in turn, used her position to advance the careers of other women physicians.

Despite her success, she never lost sight of poor women’s health needs. In addition to her work with the YWCA, Dr. McLean worked with several younger women practioners to open a free clinic in 1908, “run by women, for women.” [26 ] This clinic was run in a house at 1900 Washington Avenue and was a busy place two or three evenings a week; such hours were especially convenient for the working women whose health was always of particular concern to Dr. McLean. She continued to practice as a physician and surgeon until 1928 when she sustained a fractured wrist; complications from this injury curtailed her work in surgery. However, Dr. McLean did not give up the practice of medicine until five months before her death on May 17, 1930 – nearly forty-five years after her arrival in St. Louis.

Ninety-five years after her admission to the St. Louis Medical Society, that organization lists one hundred and thirty-nine women as members (5.5%) out of a total of twenty-five hundred physicians. Nationally, more than 26% of students currently enrolled in medical schools are women. Despite this progress, barriers to women obviously remain; few are found in certain specialties and academic positions. Whether this is due to self-restriction or more subtle discriminatory patterns remains to be seen. [27 ] It is significant that Dr. Mary Hancock McLean entered the practice of medicine as part of a women’s medical movement; the historical connection between medicine and feminism is clear. The last decade’s dramatic increase in women physicians is certainly connected to the new women’s movement. [28 ]

Dr. McLean’s achievements are even more remarkable when placed in a twentieth-century context. While she obtained a position as an assistant physician at the St. Louis Female Hospital in 1884, women were not allowed to serve as interns in municipal hospitals until 1940. [29 ] For fifteen years after her admission to the St. Louis Medical Society, she remained its only woman member. She was one of a very few women admitted to the American College of Surgeons. Though she established many precedents, it is clear that doors to other women physicians did not open swiftly because of her example. However, through a unique combination of professional skill and personal character, she was able to establish a definite place for the woman physician in the St. Louis medical community. Despite her success, and the distinguished careers of other women physicians, persistent ideas about woman’s place in medicine remain for the current women’s medical movement to overcome. In 1891, Dr. Mary Putnam Jacobi, the leading woman physician of the day, wrote:

When a century has elapsed . . . after the rights and capacities of woman as individual shall have received thorough, serious, and practical recognition . . . it will then be possible to perceive results from the admission of women to the profession of medicine . . . [30 ]

Given the long history of erroneous ideas governing woman’s place in the profession, it is fair to say that the century Dr. Jacobi referred to in 1891 has just begun.

[1] Even in these so-called woman’s professions, women were confined to particular areas. In education, women tended to teach at the lower grade levels; in nursing, women were first admitted only to wards serving women and children. For a discussion of women’s problems in entering the nursing profession, see Nancy Tomes, “Little World of Our Own: The Pennsylvania Training School for Nurses, 1895-1907,” Journal of the History of Medicine and Allied Sciences, vol. xxxiii, n. 4. October 1978. [Back]

[2] Information about Dr. McLean may be found at the St. Louis Medical Society and at the Western Manuscript Collection, YWCA Archives, at the University of Missouri, St. Louis. Anne Andre-Johnson’s book, Notable St. Louis Women (1914) contains an interview with Dr. McLean and accounts of two other (sectarian) women physicians. Dr. Ellen Loeffel’s “History of Women Doctors in St. Louis” is a useful account available at the University of Missouri YWCA archives, as are notes made by Elva Norman from conversations with Miss Gertrude Prack, a colleague of Dr. McLean’s at the YWCA. Dr. Frances Bishop’s obituary of Dr. McLean appears in the Weekly Bulletin of the St. Louis Medical Society, vol. xxiv, n. 2, June 27, 1930, pages 501-2. Dr. Simon Pollak’s account of her appears in One Hundred Years of Medicine and Surgery in Missouri, 1900, p. 41. His Autobiography and Reminiscences, (edited by Dr. Frank Lutz), 1904, mentions Dr. Nancy Leavell on p. 301. Dr. McLean is also listed in Dr. E. J. Goodwin’s History of Medicine in Missouri, 1905, p. 237. More detailed information about her personal and professional life may be found in Dr. Bertha Van Hoosen’s autobiography, Petticoat Surgeon, published in 1947. Though Dr. Mary Craffey (Osgood), an 1865 graduate of New England Female Medical College and Dr. Nancy Levell (or Leavell), an 1865 graduate of the Woman’s Medical College, Philadelphia, preceded her in practicing in Missouri, Dr. McLean’s unusually prominent reputation makes her achievements of special interest. [Back]

[3] For historical accounts of Lindenwood College, see Lucinda Templin, “Two Illustrious Pioneers in the Education of Women in Missouri,” Missouri Historical Review, vol. xxi, n. 3, April 1927, and Philip C. Davis, “The Modernization of Lindenwood College: 1903-1929,” Missouri Historical Society Bulletin, vol. xxxiv, n. 1, October 1977. [Back]

[4] For the history of women’s education at the University of Michigan, see Dorothy Gies McGuigan, A Dangerous Experiment: 100 Years of Women at the University of Michigan, 1970. [Back]

[5] The most powerful proponent of this argument was Dr. E. H. Clarke, a professor at Harvard Medical School (which did not admit women as medical students until 1945.) Dr. Clarke combined a scientific view of women’s biological inferiority with the older idea that they should be confined to the domestic sphere. His view was that higher education, of the sort provided at Vassar, could only lead to physical or mental breakdowns. He saw the problem of women’s sphere as a “problem of physiology, pure and simple.” This statement appears on page 47 of his famous book Sex in Education – or a Fair Chance for the Girls, which was published in 1873 and went through eleven editions in thirteen years. His idea of a “fair chance” for girls was to provide them with an education which would fit them for health and happiness at home. Women who believed passionately in their right to higher education were outraged by this book; Mrs. Julia Ward Howe edited a reply to Clarke by influential women physicians and educators in 1874. Entitled Sex and Education: A Reply to Dr. E. H. Clarke, the book contained an essay by Dr. Alida Avery, resident physician at Vassar College, commenting on her institution’s healthful effect on. young women. Indeed, many 19th century women argued that it was their exclusion from such activity that led to their ill health. Women physicians felt a special responsibility to rebut Dr. Clarke’s argument; in 1876 Dr. Mary Putnam Jacobi won the Boylston Medical Prize offered by Harvard University for the best essay on the effects of menstruation on women. Her research on “The Question of Rest for Women During Menstruation” concluded, on the basis of statistical case studies, that women did not need special treatment at that time. Despite her research, the debate on this question continued well into the 20th century. [Back]

[6] See Regina Morantz, “The ‘Connecting Link’: The Case for the Woman Doctor in 19th-Century America,” in R. Numbers and J. Leavitt (editors), Sickness and Health in America, University of Wisconsin Press, 1978, p. 117, and “Nineteenth Century Health Reform and Women: A Program of Self-Help,” in G. Risse, R. Numbers, and J. Leavitt (editors), Medicine Without Doctors, Science History Publications, 1977. [Back]

[7] According to a report in Medical News, February 20, 1978, pediatrics has attracted 25% of the nation’s women physicians while only 2.9% of all women physicians are surgeons. Of the almost 10,000 doctors certified by the American Board of Orthopedic Surgery, only 28 were then women. [Back]

[8] Dr. Mary Putnam Jacobi quoted this statement and others in her article “Woman in Medicine” which appeared in Annie Nathan Meyer’s book Woman’s Work in America, published in 1891, pages 139-205. [Back]

[9] Women’s medical colleges with associated hospitals for their further professional training were established in New York, Boston, and Philadelphia by 1870. Similar institutions were established in Chicago and San Francisco later in the century. When Johns Hopkins opened its medical school to women in 1894 because of stipulations Mary Garrett attached to her $300,000 gift, women students began to seek admission there and at other elite institutions. Committees of women in several cities, including St. Louis, had contributed to this fund-raising effort. Despite the high standards at certain women’s medical colleges, many felt that they were inevitably inferior because of their small endowments and limited clinical facilities. See Mary Roth Walsh, “Doctors Wanted, No Women Need Apply”: Sexual Barriers in the Medical Profession, 1835-1975, Yale University Press, 1977, p. 176-77. Regina Morantz’s review of this book is also informative, see “Women in the Medical Profession: Why Were There So Few?” Reviews in American History, June 1978, 163-170. [Back]

[10] For an account of the Social Evil Ordinance which led to the opening of a Female Hospital, see John Burnham, “The Social Evil Ordinance – a Social Experiment in Nineteenth Century St. Louis,” Missouri Historical Society Bulletin, vol. xxvii, no. 3, April 1971. [Back]

[11] Regina Morantz, “The ‘Connecting Link’: The Case for the Woman Doctor in Nineteenth Century America,” Leavitt and Numbers (editors), Sickness and Health in America, p. 121, 124. [Back]

[12] Ibid., p. 117. Morantz states that by the 1870s over 300 women had graduated mostly from sectarian medical schools. Women began to enter the regular medical profession in increasing numbers after 1870, in part because they had more opportunity to do so. The virtues of sectarian medicine were less apparent as scientific medicine developed steadily throughout the century. By 1900, there were an estimated 7000 women physicians. [Back]

[13] For an analysis of the changing character of the American Hospital see Charles Rosenberg, “Inward Glance and Outward Vision: The Shaping of the American Hospital, 1880-1920,” Bulletin of the History of Medicine, v. 53, n. 3, Fall 1979. [Back]

[14] Dr. Simon Pollak’s memoir in One Hundred Years of Medicine and Surgery in Missouri, 1900, mentions Dr. McLean on his attitude toward women physicians on page 41. [Back]

[15] Martin Kaufman, “The Admission of Women to 19th Century American Medical Societies,” Bulletin of the History of Medicine, v. 50, 1976, p. 35. Although the American Medical Association allowed Dr. Sarah Hackett Stevenson to represent the Illinois Medical Society at its 1876 Convention, her acceptance did not mean the acceptance of women physicians as members of the organization. This did not happen until the early 20th century. A separate American Women’s Medical Association was formed in 1915, but its membership never exceeded one-third of all the women physicians in the country. The choice between exclusion and separation was a frequent one for women doctors. When they were “accepted” into male organizations, their numbers were too small for them to exert an influence. However, many women doctors were wary of separatism and preferred acceptance on a limited basis to separate institutions and organizations. [Back]

[16] Simon Pollak, op. cit., note 14. [Back]

[17] Indeed, the term “woman physician” was a synonym for untrained abortionists between 1840 and 1870. See James C. Mohr, Abortion in America: Evolution of a National Policy, Oxford University Press, 1978, p. 71-3. [Back]

[18] Dr. Frances Bishop, Obituary of Dr. Mary McLean, (see note 2) is the source of both accounts. [Back]

[19] Simon Pollak, op. cit., note 14. [Back]

[20] These reminiscences are to be found in the Dr. Mary McLean files of the YWCA archives, Western Manuscript Collection, University of Missouri, St. Louis. [Back]

[21] Regina Morantz notes that “it is possible . . . as a more technical style of professionalism shaped 20th century medical practice, medicine grew less appealing to women who still clung to 19th century ideals of service.” “Women in the Medical Profession: Why Were There So Few?” (a review of Mary Roth Walsh’s book, “Doctors Wanted, No Women Need Apply”), Reviews in American History, June 1978, p. 169. Morantz’s data suggests that the phenomenon Walsh describes as a backlash against women in the medical profession after 1900 was a more complicated event which involved women’s screening themselves out of the profession by not applying to medical school. Given the impersonal quality of “modern” medicine, it is possible that women with Dr. McLean’s particular ideals would have sought employment in a new woman’s profession: social work. [Back]

[22] Howard A. Kelly, Foreword to Dr. Kate Campbell Hurd-Mead’s History of Women in Medicine, Haddam Press, 1938. It is interesting to note that Dr. McLean said that “she was greatly assisted by Dr. Kelly . . . who gave her every opportunity to witness his work in hospitals and office. It was he who advised her to branch out and do more general surgical work, including all branches of abdominal surgery. Dr. Cullen, of the same institution, was also of great assistance to her.” (Anne Andre Johnson, Notable Women of St. Louis, 1914, p. 147.) The support of influential men was obviously important at several points in Dr. McLean’s career. According to Dr. Ellen Loeffel’s “History of Women Doctors in St. Louis,” she received her assistant physician’s position at the Female Hospital with the help of General Stevenson, a friend of her father’s. (Manuscript in the YWCA archives, University of Missouri, St. Louis, Western Manuscript Collection, p. 4). Dr. Loeffel’s account calls her obtaining a position at a city hospital in the 19th century “miraculous” and notes that when Dr. McLean sought a place to set up her private practice, forty-six landlords refused to rent her an office. [Back]

[23] Dr. Frances Bishop, Obituary of Dr. Mary McLean, 1930, note 2. [Back]

[24] Ibid., p. 502. [Back]

[25] Dr. Ellen Loeffel, op. cit., p. 5. [Back]

[26] This phrase was used by Dr. Loeffel in her account of Dr. McLean’s career and is a striking parallel with current women’s self-help clinics. [Back]

[27] For a current overview of women in medicine, see Dorothy Rosenthal Mandelbaum, “Women in Medicine” (Review Essay), Signs: Journal of Women in Culture and Society, vol. 4, n. 1, Autumn, 1978. [Back]

[28] The peculiar nature of women’s progress in the medical profession during the last seventy years is evident in statistics. In 1910, 6% of all American physicians were women; as of 1976, the proportion had risen to only 8.6%. By 1976-77, women made up 24.7% of the total first-year medical school class (figures from Mandelbaum, note 27). The passage of federal legislation prohibiting discrimination on the basis of sex has helped the current women’s medical movement; such protection was, of course, not available to earlier generations of women physicians. [Back]

[29] Washington University Medical School admitted women in 1918. In 1916, the Journal of the American Collegiate Alumni Association reported that four women had registered for the pre-medical course despite the fact that no woman could then take the medical degree. “They hope to prove, through two years of very heavy work, that they are fit, physically, morally, and mentally, to receive the medical training.” Journal of the Association of Collegiate Alumnae, vol. X, November 1916. This was nearly forty years after Dr. McLean graduated from the University of Michigan. [Back]

[30] Mary Putnam Jacobi, “Women in Medicine,” Annie Nathan Meyer (editor), Woman’s Work in America, 1891, p. 204. [Back]

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