MON. MED.
         Blackwell
Medicine as a Profession for Women
           I860 
 
^\    frc*d*.i**M.  '1^dd^±__..
MEDICINE
PROFESSION FOR WOMEN. 
 
rv,s//^/fy
(».•
MEDICINE
AS A
PROFESSION FOR  WOMEN.

          Jc 3vT3 ^

       NEW YORK:
   PEINTED FOE THE TEUSTEES OF THE
NEW YORK INFIRMARY FOR WOMEN.

           1860. 
w




 1560 
MEDICINE
AS
A  PROFESSION   FOR  WOM,EN.\
     In inviting consideration to the subject of medicine as an
occupation for women, it is not  a simple theory that we wish to
present,  but the results of practical experience.   For fourteen
years we have been students of medicine;  for eight years we have
been engaged in the practice of our profession in New York :
and during the last five years have, in addition,  been actively
occupied in the support of a medical charity.  We may there-
fore venture  to  speak with some certainty on this  subject; and
we are supported by the earnest sympathy of large numbers of
intelligent women, both in England and  America,  in  presenting
this subject for the first  time  to the public.
     The idea of the education of women in medicine  is not now
an entirely new  one  ; for some years it has been discussed by the
public, institutions  have been founded  professing to accomplish
it, and many women are already engaged in some form of medical
occupation.  Yet the true position of women  in medicine, the
real need which lies at  the bottom of this movement, and the
means necessary to secure its  practical usefulness and success,  are
    * Tra lecture was prepared by Drs. Elizabeth and Emily Blackwell, as an
exposition\f the effort now being made in this city to open the profession of medicine
to women, ^^svas delivered in Clinton Hall, on the 2d of December, 1859, and is now
published at tMrequest of the trustees of the New York Infirmary for  Women. 
4
  little known.  We believe it is now time to bring this subject
  forward and place it in its true Ught, as a matter not affecting a
.  few individuals only, but of serious importance to the community
  at large; and demanding such support as wiU aUow of the estab-
  Ushment of an institution for the thorough education of women
  in medicine.
       When the idea of the practice of medicine by women is sug-
  gested^the grounds on which we usually find  sympathy expressed
  for it are two." The first is, that there are certain departments of
  medicine in which the aid of women physicians would be especi-
  ally  valuable to women.   The second  argument is, that women
  are much in need of a wider field of occupation, and if they could
  successfuUy practice any branches of medicine  it would be another
  opening added to the few they already possess.  In some shape
  or other, these two points are almost universally regarded (where
  the matter has been considered at aU) as the  great reasons  to be
  urged in its behalf.
       Now, we beUeve that both these reasons are vaUd, and that
  experience wiU fully confirm them;  but we beUeve  also that
  there is a much deeper view of the question than this; and that
  the thorough education of a class of women in medicine wiU  ex-
  ert an important influence upon the life  and  interests of women
  in general, an influence of a much more extended nature than is
  expressed in the above views.   The question  of the real value to
  the  community of what women may do in medicine is an emi-
  nently practical matter,  for upon it  is based  the aid which they
  may ask for its accompKshment; and upon the position of wo-
  men in medicine depends the kind and extent of education which
  should be given  to fit them for it.   A great  deal of well-meant
  effort has been, and is stiU being expended upon the institutions
  which have  been estabUshed for this  purpose.   Sometimes  we
  have heard much discouragement expressed at the j£ht  result
  that has Mowed from them; whUe, on the other h&d, it is often 
5
said, " after aU, it is a matter for women to settle for themselves,
if they can be doctors, and want to, they wUl find the way to do
it, there is no Efeed of doing any thing in the matter."  Now as I
have said, we beUeve it to be by no means a matter concerning
only the limited number of women who may be actuaUy engaged
in the pursuit itself; and it is also certain that to insure the
success of the work it is not enough that women should wish to
study, the cooperation and support of pubUc sentiment is needed
to enable them to do so.  We hope, by showing the value of the
work, to prove it to be the interest of the community to carry it
out;  and we desire to show the  means by which this  may be
done.
  Let me then say a few words on the influence which would be
exerted on  society by the opening of medicine as a profession to
women.  The interests  and occupations of women, as they ac-
tually are at present, may be referred to four distinct forms of
effort:—Domestic Ufe ;  the education of youth; social inter-
course, and benevolent effort of various kinds.   AU these avoca-
tions, by unanimous  consent, are especially under the superin-
tendence of women, and  every woman,  as she  takes her  place  in
society, assumes  the responsibiUty of participation in some of
them.
   While these pursuits  have always formed the central interest
of the majority of women, their character, and the requirements
which they make for their proper performance, have widened, with
the advance of modern society, in a remarkable degree.  Social
intercourse—a very limited thing in a half civiUzed country, be-
comes in our centres of civiUzation a great power, establishing
customs more binding than laws, imposing habits and stamping
opinions, a tribunal from whose judgment there is hardly an ap-
peal.  AU  who are  familiar with  European life, and the life  of
our great cities, know what an organized and powerful force it
aver tends  to become. 
6
    In like manner, benevolent efforts have little influence in new
countries, but in Europe, especially in England, the extent  of
such work, and the amount of it which is done by women would
be incredible, did we not see here, in our midst, the commence-
ment of a similar state of things.
     Domestic life is not less affected by the growth of the age ;
the position and duties of the mother of a family call for very
different qualifications, in  the wide and complicated  relations  of
the present, from what was needed a century ago.
     Now it is evident that the performance of all these forms  of
work, extended and organized as they are, is in its practical na-
ture a business requiring distinct knowledge and previous prepa-
ration, as much as actual trades and professions.  This fact would
be more commonly recognized were it not that there is  so much
moral and  spiritual life interwoven into woman's work by the re-
lations upon which it is founded, and out of which it grows, as to
make it more difficult to separate this business aspect of her work
from her personal life, than is the case with the business life  of
men ; consequently its practical character is too often considered
entirely subordinate, or lost sight  of.   Every woman, however,
who brings thought and conscience to  the performance of every-
day duties, soon realizes it in her own experience.  The wider the
view she takes of life, the higher her ideal of her domestic and
social relations, the more keenly she will feel  the need of knowl-
edge with  regard to this  matter of  fact basis upon which  they
rest.  The first and most  important  point in which she will feel
the want  of this previous training will be in  her ignorance  of
physiological and sanitary science, in their application to practi-
cal life ;  of the laws of health and physical and mental develop-
ment ; of the connection between moral and physical conditions,
and the influences which our social and domestic life exert upon
us.  These and simUar questions will meet her at every step, from
the commencement of her maternal life, when the care of youn- 
7
children and of her own health bring to her a thousand subjects
of perplexity, to the close of her career, when her chUdren, assum-
ing their positions as men and women, look to her as their natural
counseUor.
     It may be said, at first sight, that in these things it is not so
much knowledge as common sense and earnestness that is wanted ;
that as health is the natural condition, it will be secured by sim-
ply using our judgment in not positively disregarding what our
natural instincts  teach us in regard to our lives.   This would  be
true if civilization were a simple state directed by instinct; but
every advance in social progress removes us  more and more from
the guidance of instinct, obUging  us to depend  upon reason for
the assurance that our habits are really agreeable to the laws  of
health, and compeUing  us  to guard against the sacrifice  of our
physical or moral nature whUe pursuing the  ends of civiUzation.
     From the fact, then, that our lives must be directed more by
reason than instinct, arises  at once the necessity for a science  of
health, and that comprehension of it which  will lead to its daily
application.  Take in illustration the simplest physical need, that
which is most completely instinctive in its  character—the ques-
tion of food.  Animals make no mistake on this point, being gov-
erned infallibly by instinct, but what conflicting theories it has
given rise to among men !  It is very rare to find among women,
the heads of families, any clear  idea of what  are the requisites for
a healthy table;  and what is true of  this  very simple material
want is  stiU more so with regard to higher questions of physical
law, those more intimately  connected with the inteUect and affec-
tions, and  the  family and  social relations growing out of  them.
Nothing is more striking in a wide observation of daily life  than
the utter insufficiency of simple common sense to secure wise ac-
tion in these matters.   Numbers of people, of very good common
sense in other things, violate  the fundamental laws  of health
without knowing it; and when they think upon the subject they 
8
are just as likely to foUow some crude popular theory as  to find
out the truth.
    That progress  is needed in sanitary matters  is  widely  ad-
mitted ; sanitary conventions are held; the medical profession
and the press are constantly caUing attention to defects of pub-
Uc  and private hygiene, pointing out the high rate of mortaUty
amongst chUdren, etc.;  but it is far from being as generaUy re-
cognized  how essential to progress it is that women, who have
the domestic life of the nation in their hands, should reaUze their
responsibiUty, and possess the knowledge necessary to meet it.
    In education, as in domestic life, the  same necessity for hy-
gienic knowledge exists.  Statistics show that nine-tenths of our
teachers are women, and it is obviously a matter of great import-
ance that they should be famiUar with the nature and needs of
the great body of youth which is intrusted to their care.  It is
not possible that our systems of education should be reaUy suited
to childhood, training its faculties without cramping or unduly
stimulating the nature, unless  those by whom this work is done
understand the principles of health and growth upon which school
training  should be based.  Our  school education ignores, in a
thousand ways, the rules  of healthy development;  and the re-
sults, obtained with much labor and expense, are gained very gen-
eraUy at the cost of physical and mental health.
    If, then, it be true that health has its science as weU as dis-
ease ; that there are conditions essential for securing it, and that
every day life  should  be based upon its  laws; if, moreover,
women, by their social position, are important agents in this prac-
tical work, the question naturally arises, how is this knowledge
to be widely diffused  among  them ?   At  present  there exists no
method of supplying this need.  Physiology and all branches of
science bearing upon the physical life of man are pursued almost ex-
clusively by physicians, and from these branches of learning they
deduce more or less clear ideas with regard  to the conditions of 
9
 health in every-day life.  But it is only the most  enUghtened
 physicians who do this work for themselves ; a very large propor-
 tion of the profession, who are well  acquainted with  the bearing
 of this learning upon disease, would find it a difficult matter to
 show its relation to the prevention of disease, and the securing of
 health, by its appUcation to daUy Ufe.  If this be the case with
 regard to physicians, it must evidently be impossible to give to
 the majority of women  the  wide scientific training  that would
 enable them from their own  knowledge to deduce  practical  rules
 of guidance.  This must be done by those whose avocations re-
 quire wide scientific knowledge—by  physicians.  Yet  the medical
 profession is at present too far removed from the Ufe  of women ;
 they regard these subjects from such a different stand-point that
 they can not supply the want.  The appUcation of scientific knowl-
 edge to women's necessities in actual Ufe can only be done by women
 who possess at once the  scientific learning of the  physician, and
 as women a thorough acquaintance with women's requirements—
 that is, by women physicians.
     That this connecting link between the science  of the medical
 profession and the every-day Ufe of women is needed, is proved by
 the fact that during the years that scientific knowledge has been ac-
 cumulating in the hands  of physicians, whUe it has revolutionized
 the science of medicine, it has had so little direct effect upon do-
 mestic Ufe.  Twenty years ago, as now, their opinion was strongly
 expressed with regard to  the defects  in the adaptation of modern
 life and education to the physical weU being of society, and  par-
 ticularly of its  injurious results to women.  Yet,  as far as these
 latter are concerned, no  change has been effected.  In aU  such
 points women are far more influenced by  the opinions of society
 at large, and of their elder women friends, than by their physi-
 cian, and this arises from the fact that physicians  are too far re-
moved from women's life; they can criticize but not guide it. On
the other hand, it is curious to observe that, as within the last few 
10
  years the attention of a considerable number of women has been
  turned to medicine, the first use they have made of it has been to
  establish a class of lecturers on physiology and hygiene for women.
  They are scattered aU over the country; the lectures are generally
  as crude and unsatisfactory as the medical education out of which
  they have sprung ; but the impulse is worthy of note, as show-
  ing the instinctive perception of women, as soon as they acquire
  even a sUght acquaintance with  these subjects, how directly they
  bear upon the interests of women, and  the inclination which ex-
  ists to attempt, at least, to apply them to their needs.  As teach-
  ers, then, to diffuse among women the physiological and sanitary
 knowledge which they need, we find the first  work for women
 physicians.
     The next point of interest to be noticed is the connection of
 women with pubUc charities and benevolent institutions.
     In aU civiUzed nations women have always taken an active
 share in these charities;  indeed,  if we include those employed in
 the subordinate duties of nurses, matrons, etc., the number of
 women actually engaged would much outnumber that of men.
 How large a part of the character of these institutions, and of the
 influence exerted by them upon society, is dependent upon  this
 great body of women employed in them and connected with them,
 may readily be  imagined.   Yet it is certain, and admitted by all
 who have any acquaintance with the matter,  that this influence
 at present is far from being a good one.  It is well known how
 much  the efficiency of women  as managers or  supporters  of
 pubUc institutions is impaired by the lack of knowledge and prac-
 tical tact to second their zeal;  and business men who have deal-
 ings with them in these relations are very apt to regard them
 as troublesome  and uncertain allies, rather than as efficient co-
workers.  With those employed in the active care of the institu-
tions the case is still worse; the very term hospital nurse conveys
the idea of belonging to a degraded class. 
11
     How to obviate this great evil has become an important ques-
 tion.  In England, where all public institutions, hospitals—civil
 and military—workhouses, houses for reformation, prisons, peni-
 tentiaries, etc., form a great system, dealing with the poorer classes
 to an immense extent, and  having a social importance too seri-
 ous to be overlooked, the question has assumed sufficient weight
 to  be  discussed  earnestly  by government and the  public  at
 large.
     In CathoUc countries this is accomplished to a certain ex-
 tent—that is, as far as the domestic and nursing departments are
 concerned—by the religious orders, the sisters of charity and others.
 Every one who is familiar with such institutions must have been
 struck by the contrast  between the continental and English hos-
 pitals, etc., caused by this one thing, by the cheerful and respect-
 able home-like air of well-managed French establishments, as com-
 pared with the gloomy, common aspect of even wealthy English
 or American charities ; and  must have  observed the salutary in-
 fluence upon  patients, students, and all connected  with these
 places, of the  presence and  constant superintendence  of women
 who, instead of being entirely common and subordinate, are uni-
 versally regarded with respect and confidence, and by the poorer
 classes almost with veneration.
     It is very common among both Catholics and Protestants to
 consider these sisterhoods as the result entirely of rehgious  en-
 thusiasm, and to assert that large  bodies of women can only be
 induced to accept these occupations, and carry them out  in this
 efficient manner from this motive.  When efforts have been made
 in England and Germany to establish any thing of the kind among
 Protestants, it is always to the religious element that the appeal
 has been made.  Many such efforts have been made, with more or
 less success, in Germany. In England, the results have been very
imperfect, and have entirely failed to secure any thing approach-
ino- in practical efficiency to the Catholic sisterhoods. 
12
    Now these faUures are very easily comprehended by any one
who has seen much of these sisters in actual work, for such per-
sons will soon perceive that the practical success of these orders
does not depend upon religious enthusiasm, but upon an exceUent
business organization. Religious feeUng there is among them, and
it is an important aid in fiUing their ranks and keeping  up their
interest; but the real secret of their success  is in the excellent
opening afforded by them for aU classes of women to a useful and
respected social life.  The inferior sisters are plain, decent women,
nothing more, to whom the opportunity of earning a support, the
companionship, protection and interest afforded by being members
of a respected order, and the prospect of a certain provision for
age, are the more powerful  ties to  the work, from the fact that
they are generally without means, or very near  connexions, and
would find it difficult to obtain a better or so good a living.  The
superior sisters are usuaUy  women of character and education,
who, from want of famUy ties, misfortune, or need of occupation,
find themselves lonely or unhappy in ordinary life ;  and to them
the church, with its usual sagacity in avaiUng itself of all talents,
opens the attractive prospect of active occupation, personal stand-
ing and authority, social respect, and the companionship of intel-
Ugent co-workers, both men and women—the feeling of belonging
to the world, in fact, instead of a crippled and isolated life.  For
though it is common to speak of the sisters  as renouncing the.
world, the fact is, that the members of these  sisterhoods have a
far more active participation in the interests of life than most of
them had before. No one can fuUy reaUze the effect this has upon
them, unless they have at once seen them at their work, and are
aware how welcome to  great numbers of women would be  an
active, useful life, free from pecuniary cares, offering sympathy
 and companionship in work and  social standing to aU its  mem-
bers, with scope for aU talents, from the poorest drudge to the in-
 telligent and educated woman—an offer so welcome as to be quite 
13
sufficient to overcome the want of attraction in the work itself at
first sight.
     As we have said, every effort so far to introduce a correspond-
ing class of women into EngUsh institutions has proved a faUure,
for there is no  such organization in external life in Protestant
churches as there is in the CathoUc ; it is contrary to the genius
of the nation;  and the same results  would certainly follow in
America.
     The only way to meet the difficulty,  to give a  centre to
women who are interested in such efforts, and  to  connect in-
telligent women with these institutions, is  to introduce women
into them  as  physicians.   If  all public charities were open to
well educated women physicians, they would exert  upon them
the  same  valuable  influence  that is  secured by the  presence
and services of the superiors of these orders ; they would bring
in a more respectable class  of  nurses and train them, which
no  men can  do ; they would supervise the domestic  arrange-
ments, and give the higher tone  of womanly influence so greatly
needed.
     They would be at the same time a connecting Unk between
these estabUshments  and women in  general life,  enlisting their
interest and active services in their  behalf, far more effectuaUy
than could be done by any other means.   A real and great want
would thus be suppUed, and  one which no other plan yet pro-
posed has  proved at aU adequate to meet.
    We come now to  the position of women in medicine itself.
The fact that more than half of ordinary medical practice  lies
among women and children, would seem to be, at first sight proof
enough that there must be here a great deal that women could do
for themselves, and that it is not a natural arrangement that in
what so especiaUy concerns themselves, they should have recourse
entirely to men.   Accordingly we find that, from the very earUest
ages, a large class of women has always existed occupying certain 
14
 departments of medical practice.  Until within half a century, a
 recognized position was accorded to them, and midwives were as
 distinct a class, as doctors.  Even now, in most European coun-
 tries, there are  government schools for  their instruction, where
 they  are  most carefully trained  in their  own speciality.   This
 training is always given in connexion with a hospital, of  which
 the pupils perform the actual practice, and physicians of standing
 are employed as their instructors.  In Paris, the  great hospital
 of La Maternite, in which several thousand women are received
 annually,  is entirely given up to them, and Dubois,  Professor of
 Midwifery in the medical school of  Paris, is at the head of their
 teachers.   Until within  a few years, it was common for eminent
 French physicians to receive intelligent midwives as their private
 pupils, and take much pains with their  education.  They were
 also admitted to courses of anatomical instruction in the Ecole
 Pratique,  and an immense amount  of  practice was in the  hands
 of these women.  The whole idea of their education, however,
 planned and molded entirely by men, was not to enable these wo-
 men to do all  they could  in medicine,  but  to make them a sort
 of supplement to the profession, taking off a great deal of labori-
 ous poor practice, and  supplying a certain  convenience in some
 branches where  it was advantageous to  have the assistance of
 skilful women's  hands.  With the advance of medical science,
 however, and its application to all these departments of medicine,
 this division of the directing head, and the subordinate hand, be-
 came  impossible.   Physicians dismissed, as far as  possible, these
 half-educated assistants, excluded them from many opportunities
 of instruction under their authority, and in the government schools,
 which popular custom stiU upholds, they have materially curtailed
their education.   Nor is it possible or desirable  to sanction the
practice of any such intermediate class.   The  alternative is un-
avoidable of banishing women from medicine altogether, or giving
them  the education and  standing of the  physician.   The  broad 
15
field of general medical science underUes all speciaUties, and an
acquaintance with it is indispensable for the successful pursuit of
every department.  If the popular instinct that caUed women so
widely to this sort of work represent a real need, it can only be
met now by a class of women whose education shaU correspond
to the wider requirements of our present medical science.
     Moreover, experience very soon shows  that it is not these
special branches  of practice that wiU chiefly caU for the attention
of women in medicine.  The same reason which especiaUy quaU-
fies women to be the teachers of women, in sanitary and physio-
logical knowledge, viz., that they can better apply it to the needs
of women's life, holds good in regard to their action as physicians.
So much of medical  practice  grows out of  every-day conditions
and interests, that women who are thoroughly conversant with
women's lives wUl, if they have the character and knowledge
requisite for the position, be as much better qualified in many
cases to counsel women, as men would be in simUar circumstances
to counsel men.  At present, when women  need medical aid or
advice, they have at once to go out of their own world, as it were;
the whole atmosphere of professional life is  so entirely foreign to
that in which they live that there is a gap between them and the
physician whom  they consult, which can only be filled up by mak-
ing the profession no longer an exclusively mascuUne one.  Medi-
cine is so broad  a  field, so closely interwoven with general inter-
ests, deaUng as it does with all ages, sexes,  and classes, and yet
of so personal a character in its individual  applications, that it
must be regarded as one of those great departments of work in
which the cooperation of men and women is needed  to fulfill aU
its requirements.  It  is not only by what women wUl do them-
selves in medicine, but also by the influence which they wiU exert
on the profession, that they wiU lead it to supply the needs of
women as it can not otherwise.
    Our own experience has fuUy proved to us the correctness of 
16
this view.  We find the practice, both public and private, which
comes naturally to us is by no means confined  to any special de-
partments, and where patients have sufficient confidence in us to
consult us for one thing, they are very apt to apply in all cases
where  medical aid is needed.  The details of our medical work
during the number of years that we have been connected with
the profession can not be given to the pubUc, but they have fully
satisfied us that there wiU be the same variety in the practice of
women as exists in that of men ; that individual character and
quaUfication will determine the position in practice, rather than
pre-conceived ideas with regard to the position ; and that there
is no department in which women physicians may not render valu-
able services to women.
    It is often objected to this idea of professional and scientific
pursuits for women that it is too much out of keeping  with their
general life, that it would not harmonize with their necessary avo-
cations in domestic and social life; that the advantages to be
gained from the services of women physicians would not compen-
sate for the injurious effect it would have upon the women them-
selves who pursued the profession, or the tendency it might have
to induce others to undervalue the importance of duties already
belonging to them.
    This  objection,  the prominent  one which we usuaUy meet,
appears to us based on an entire  misapprehension of what is  the
great  want of women at the present  day.  AU who  know  the
world must acknowledge how far the influence of women in  the
home, and  in  society, is from what it should be.  How often
homes, which should be the source of moral and physical health
and truth, are centers of selfishness or frivolity !  How often we
find women, weU meaning, of good inteUigence and moral power,
nevertheless utterly unable to influence their homes aright.  The
chUdren, after the first few years of life, pass beyond the" influence
of the mother. The sons have an entire life of  which she knows 
17
nothing, or has only uneasy misgivings that they are not growing
up with the moral truthfulness that she desires.  She has not the
width of view—that broad knowledge of life, which would enable
her to comprehend the growth and needs of a nature and position
bo different from hers  ; and if she retain their personal affection,
she can not acquire that trustful confidence which would enable
her to  be  the guardian friend  of their early manhood.   Her
daughters also lack  that guidance which would come from broader
views of life, for she can not give them a higher perception of
life than she possesses herself.  How is it, also, with the personal
and moral goodness attributed to woman, that the tone of social
intercourse, in which she takes so active a part, is so low ?  That,
instead of being a counterpoise to the narrowing  or self-seeking
spirit of business life,  it only adds an element of frivolity and dis-
sipation.
    The secret of this faUing short from their true position is not a
want of good instinct, or desire for what is right and high, but a nar-
rowness of view, which prevents them from seeing the wide bearing
of their duties, the extent of their responsibiUties, and  the want of
the practical knowledge which would enable them to carry out a more
enUghtened conception of them.  The more connections that are
established between the Ufe of women and the broad interests and
active progress of the age, the more fully wiU they reaUze this wider
view of their work.  The profession of medicine which, in its prac-
tical detaUs, and in the character of its  scientific basis, has  such
intimate relations with these every-day duties of women, is pecu-
Uarly adapted as such a means of connection.   For what is  done
or learned by one class of women becomes, by virtue of their com-
mon womanhood, the property of aU women.   It teUs upon their
thought and action, and modifies their relations to other spheres
of life, in a way that  the accomphshment of the same work by
men would not do.  Those women who pursued this Ufe  of sci-
entific study and practical activity, so different from woman's do-
                              2 
18
mestic and social life and yet so closely connected with it, could
not faU to regard these avocations from a fresh stand-point, and
to see in a new Ught the noble possibUities which the position of
woman opens to her; and  though they may be  few in number,
they wiU be enough to form a new element, another channel by
which women in general may draw in and apply to their own needs
the active life of the age.
    We have now briefly considered the most important grounds
on which the opening  of the profession of medicine to women is
an object of value to society in general, and  consequently having
a claim upon the  pubUc for aid in its accompUshment.  Let me
now state briefly what are the means needed for this purpose.
    The first requirement for a good medical education is, that it
be practical, i. e., that the actual care of the sick and observation
by the bedside should be its foundation.  For this reason, it must
be given in connection with a hospital.   This essential  condition
is equally required for the more limited training of the  nurse,
which, though perfectly distinct in character and object  from that
of the physician,  agrees with it in this one point of its practical
nature.   In Europe, the  shortest period of  study required for a
physician's degree is four years, and at least ten months of each
year must be spent in attendance upon the course of instruction.
This course comprises not only lectures on the different branches
of medicine, but  thorough practical study of chemistry, botany,
anatomy, etc., in the laboratory, gardens, museums, etc.   Attend-
ance on the hospitals is also required, where, for several years, the
student is  occupied with subordinate medical and surgical duty.
This hospital  training is the foundation of their education, and
the lectures are Ulustrative of it,  not  a substitute for it.  In
England, no medical school can confer a degree that has not at-
tached to it a hospital of as many as one hundred beds.  And in
many of  the beat schools, as that of St. Bartholomew's, of Lon-
don, the coUege department  will only number forty or fifty stu- 
19
dents, who perform aU the  assistants' duty of a hospital of five
hundred beds, with an out  practice of eighty thousand patients
anmiaUy.  In America, though so extensive and thorough an ed-
uction is not legally required, yet all students who attain any
standing in the profession pass through essentially the same course,
because nothing short of it wiU  enable them to meet the respon-
sibilities of practice with success.
     The chief difficulty in the way of women students at present
is, as it always has been, the impossibility of obtaining practical
instruction.  There is not in America a single hospital or dispen-
sary to which women can gain admittance, except  the limited op-
portunities that have been obtained in connection with the New
York Infirmary.   This difficulty met us during our own studies,
and we were  obliged to spend several  years in Europe to obtain
the facilities we needed. Even there, no provision  is made for the
admission  of women, but there  are so many great hospitals in
both London and Paris that only those distinctly  connected with
medical schools are crowded  with students.  There are many large
institutions attended  by distinguished physicians, comparatively
little frequented by them, and in these a lady, with good intro-
ductions, can, if she wiU give the time and patience, find good op-
portunities for study.
     This troublesome and  expensive  method  is stiU the only
way in which a woman can obtain any thing that deserves to be
caUed a medical education, but it  is evidently beyond the means
of the majority of women.   The  instruction that they have hith-
erto been able to obtain in the few medical schools that have re-
ceived them  has  been purely theoretical.   It consists simply of
courses  of lectures, the students being rigorously excluded from
the hospitals  of the city, which are only open to men.  Some
three hundred women have attended lectures in these schools, the
majority of them being intelligent young women, who would proba-
bly have been teachers had they not chosen this profession.  Thej 
20
enter the schools with very Uttle knowledge of the amount and
kind of preparation necessary, supposing that by spending two or
three winters  in the prescribed  studies they will be qualified to
begin practice, and that by gaining experience in practice itself
they will gradually work their way to  success.  It is not  until
they leave coUege, and attempt, alone and unaided, the work of
practice that they realize how  utterly insufficient  their educa-
tion is to enable them  to acquire and  support the standing of
a physician.   Most of them, discouraged, having spent aU  their
money, abandon  the profession; a few gain  a Uttle practical
knowledge  and struggle into  a  second-rate position.  No judg-
ment can be formed of women as physicians under such circum-
stances.  It would be  evidently an  injustice  to measure  their
capacity for such occupation by their  actual  success, when aU
avenues  to  the necessary instruction  are resolutely closed to
them.
     Realizing the necessity of basing any system of instruction
for women on  actual practice,  we resolved, seven years ago, to lay
the foundation of  such an institution as was needed.  A number
of well-known citizens expressed their approval of the undertak-
ing, and kindly consented to act as trustees.   We then took out
a charter for a practical school of medicine for women. This  plan
was founded upon those of European hospital schools.   It  is as
follows: To a hospital, of not less than one hundred beds, lecture-
ships are to be attached, for the different branches of medical
science, with clinical teachers to give instruction in the wards.
The students should be connected with it  for four years, and
should serve as assistants in the house, and  in out-door prac-
tice.  Amongst the professorships attached to the hospital should
be one of sanitary  science, of  which the object is to  give in-
struction on the laws of health,  and aU points of public and pri-
vate hygiene,  so far as  science and practical life have taught us
with regard to them.   This  professor should  also supervise the 
21
sanitary arrangements of the hospital itself, and  should be the
chief of the system of instruction for nurses.   We beUeve  that
this professorship would be of real and important value, not  only
in giving the students a thorough acquaintance with the laws and
conditions of health, and fuUy imbuing them with the idea  that
it is  as much the province of the physician to aid in preventing
as in curing disease, but also as affording to teachers and mothers
the opportunity of obtaining  that sort of knowledge which we
have shown they so much need, and yet have no means of acquir-
ing.   In this hospital we would also estabUsh a system of instruc-
tion  for nurses.   The plans for  this  instruction are based upon
those drawn up by Miss Nightingale for her proposed nursing
school in London,—plans, the  result of  her long and wide ex-
perience, which, unfortunately, her iU health wiU probably pre-
vent her carrying out, but with which, though never  yet  pub-
Ushed, we are weU acquainted.
     This is a slight sketch of the mode in which we wish to carry
out the three-fold object  of the institution, viz., the education of
physicians, the training  of nurses, and  the diffusion of sanitary
knowledge amongst women.
     It is evident that to organize such a hospital school would be
a costly undertaking.  It could not  be self-supporting, for stu-
dents are generaUy barely able to pay for their own direct instruc-
tion  ; and the hospital  foundation, the apparatus for teaching,
and in the professorships, must be at least in part supported by
endowment.   It would require, therefore,  a very large sum to or-
ganize such an institution of the size  I  have described, and it
could not be efficiently carried out on a smaller scale, but could
we awaken in the pubUc a conviction of the value of the object,
we believe that any amount really needed to accomplish it would
be raised.
     When  we took out our charter we  knew that, having few
friends to aid in the  effort, we  must work  graduaUy  toward so 
22
large an end.  We accordingly began the New York Infirmary,
as a smaU dispensary, in a single room, in a poor quarter of the
city, open but a few hours during the week, and supported by the
contributions of a few friends.  Three years ago  we had grown
sufficiently to take the house now occupied by the institution,
No. 64 Bleecker street, and with the same board of trustees and
consulting physicians we organized a small house department.
This year the number of patients treated by the Infirmary is
about three thousand seven hundred.  Although the institution
is much  too small  to enable us  to organize any thing like a
complete system of instruction for students or nurses, we have
received into  the house  some of  the elder students  from  the
female medical schools, and a few  women who have applied for
instruction in nursing.   We have thus become  more familiar
with their needs, and better able to shape the  institution toward
meeting them.
    Although we can not yet realize  the ultimate objects to-
ward which we are working, the institution, even of its present
size, is of veiy great  value.  In the first place, the fact that  the
entire medical practice of such  an institution is  performed by
women is the best possible proof to the public of the possibility
of the practice of Avomen, since,  being public in its character, its
results are known, as those of private practice  can not be.   Sec-
ondly, it is  already a valuable medical  centre for women.   The
practice of a public institution, however small, establishes con-
nexions between those who conduct it and others engaged in va-
rious  public charities ;  and  from  the relations thus formed we
have already been able to obtain faciUties for students in the city
dispensaries, and in  private classes, that could not be obtained
had we not such a centre to work from.   Indeed, so effectual has
it proved already in this manner,  that were it established on a
permanent basis, we  could, by its assistance, and our connexions
w th the profession here  and in Europe, enable individual stu- 
24
sand patients received free medical aid last year; no other city in
the Union compares with this in its need of medical charity.  It
is here, therefore, that a coUege hospital for women should be es-
tabUshed.  We have been urged to commence this work in Eng-
land, and offers of valuiible aid have been made for this purpose.
But this medical work has  originated here, and we beUeve that it
is better suited to the spirit of this than of any other country.  As
America, therefore, has taken the initiative in this medical reform,
let us do the work weU.
     I said to EngUsh friends before I left them, " You must send
us over students, and we wiU educate them in America to do the
same work in England."  The cordial reply was, " We wUl send
them over if we can not prevail upon you to return to us."
     Now, therefore, America must help us to redeem the pledge
of education which we have given in her behalf.
     Help us to bmld up a noble institution for women, such an
institution as no country has ever yet been blessed with, a national
coUege  hospital, in which aU parts of the Union shaU join.   Let
it not be a  name merely, but a substantial fact, wisely planned
and Uberally endowed.
     Surely this awakening desire  of women to do their duty in
the world more earnestly, and to overcome, for a great and good
end, the immense difficulties which stand in their way, will enUst
the sympathy and support  of every generous man and woman.
     Help us, then, friends !  Join the Uttle band of workers that
has borne so bravely with  us the odium of an unpopular cause.
Help us fight this good fight, and achieve the victory, the victory
of erecting a noble centre of instruction for women, which shaU
be not only a glory to the New World, but a blessing to the Old
World too! 
23
dents, possessing the requisite means, to obtain a good medical
education before the institution itself can offer the complete edu-
cation which I have described.
    It is, moreover,  a charity which  is of much value to  poor
women, as  being the  only one where  they can obtain the aid of
women physicians. We have only been able to keep a very small
number of  beds, but they are constantly occupied by a succession
of patients, and we could fill a much larger number if we were
able to support them.  Our dispensary practice is constantly in-
creasing.
    We believe, therefore, that, quite independent of the broader
work  that  may be ultimately accomplished, in its. present  shape
as a charity to poor women, as  a  proof of women's ability to
practice  medicine, and as a medical centre for women, this insti-
tution is well worthy of support.                             T~
    What we ask from those who are  interested in the objects we
have stated is to  assist in raising a  fund for endowment which
Bhall place  the institution  on a secure foundation.  It has hith-
erto been supported almost exclusively by the subscriptions of a
few friends, who pledged  themselves for certain sums during three
years.   It  has been  a principle  of management distinctly laid
down, that the infirmary should  not go into debt  or on credit;
that every  year's  expenses should be collected in advance, and
should  never be allowed  to exceed the sum in the treasury at its
commencement.  This rule will  be steadily adhered to, and no
extension of operations undertaken until the funds are actually
coUected for that purpose.  But so long as we are obliged to collect
the income by subscription only from year to year we are not able
even to lease a house, or make any arrangement for more than one
year, but are  obliged to  devote to the work of its material sup-
port the time and attention that  should  be given towards organ-
izing and furthering the objects of the institution.  New York is
the true centre of medical education.   One hundred and fifty thou-