A History of Women’s Entrance Into Medicine

Political context

The second decade of the Empire was a turning point for France. [1]In 1867, Victor Duruy, Minister of Public Instruction, created secondary courses for young women. These were such a success that there were soon 250 to 300 young women attending every course given at the Sorbonne. [2] But although these courses were popular in the liberal bourgeoisie [3], they did not compensate for the absence of a secondary education that would provide women with the knowledge necessary to take the baccalaureate diploma and to register at University. In France, as no structure was specifically designed for them, women had to impose themselves among male students. In 1861, Julie Daubié registered for the baccalaureate and took it in Lyon (she was refused permission to do so in Paris). However, she was an exception. In other countries, the situation was different: in Russia, England, the United States, Rumania and still other countries, young women could attend secondary courses either in private schools created especially for them (and often by them, too) or in public schools that were female only. In Russia, although secondary education remained open to women, the Russian government decided in 1862 to close Saint Petersburg’s private higher education schools for women. Young Russian women however, contrary to French young women, had access to the instruction necessary for further education. Thus, the first woman to enter a medical school was Russian.

In 1864, a Russian young woman left her country to study medicine in Zurich. In the fall, she solicited from the Swiss Senate the authorization to attend the classes in natural history, anatomy and histology given at the University of Zurich. She got the approval of the professors and the Senate granted her request; but in the end she did not take her degree. In 1865 Nadejda Souslova was in turn accepted at Zurich. In 1866, she requested the right to defend a doctoral thesis; she thus became the first woman doctor to graduate from a mixed European university. [4]Nadejda Souslova’ success immediately reverberated among Russian, English and American women.

First female admissions in Paris

In 1866, the dean of the Faculty of Medicine, Charles Adolphe Wurtz (1817-1884), met Madeleine Brès (1839-1925), who wanted to undertake medical studies. Wurtz advised her to start with taking the baccalaureate examinations, but he also promised her that he would plead her case to the Ministry of Public Instruction.

As he knew that two years earlier women had been allowed at the medical school in Zurich, Wurtz asked Doctor Alexis Dureau (1831-1904) to go there. Dureau wrote: "Dean Wurtz thus commissioned me to enquire about everything that was related, from both a legal and a practical point of view, to admitting women into foreign universities." [5]

After Dureau’s return, Wurtz submitted to Victor Duruy a report on female education across Europe and was able to win Madeleine Brès’s case. But before Madeleine Brès came back with her baccalaureate degrees, three foreign women had already been admitted to the medical school: Mary Putnam (American, born in London), Catherine Gontcharoff (Russian), and Elizabeth Garrett (English).

The world of medically educated women, although geographically quite large, was numerically restricted enough for a network to develop quickly. In 1867, the Englishwoman Elizabeth Garrett wrote to Mary Putnam, who was trying to gain admission to the Paris faculty of medicine, to enquire about the outcome of her attempt. When she learnt that Mary Putnam had been admitted, Elizabeth Garrett crossed the Channel and registered too. She became the first woman doctor of the Faculty of Medicine of Paris with a thesis on migraines that she defended on June 15, 1870.

When Madeleine Brès applied to register in 1868, after obtaining her baccalaureate degrees, the procedure had already ceased to be exceptional. In 1875, she became the first French female doctor of medicine.

Over the next few years, female students went either to the Faculty of Zurich or to that of Paris. In France, over the first 15 years, the majority of female students were of Anglo-Saxon origin. But as of the mid-1880s most of them came from Slavic countries. French women in the University long remained a minority, especially as they started being admitted to medical preparatory schools in the provinces, not at all attended by foreigners. In Paris, there were less than 10 women in medical school before 1873; less than 40 from 1873 to 1881; a hundred in 1884. In 1887, out of the 114 women undertaking medical studies, no more than 12 of them were French; 70 were Russian, 20 Polish, 8 English, 1 North American, 1 Austrian, 1 Greek, and 1 Turkish. [6]

Mary Putnam

Mary Putnam (1842-1906), who graduated in 1863 from the New York College of Pharmacy and in 1864 from the Woman’s Medical College in Philadelphia, arrived in Paris in 1866. Although she was mainly interested in chemistry, she gladly followed Dr. Hippolyte Herard (1819-1913), who was a friend of her father’s, as he gave clinical lectures at the hospital. During the academic year 1866-1867, Herard gave her access not only to the medical world but also to several clinical lectures, including Benjamin Ball’s. At the beginning of the year 1867-1868 she was granted permission to study in a booth reserved for her in the library of the Faculté de médecine. In November 1867, she requested the permission to enroll officially at the Faculté.[7] The faculty assembly convened on November 27, 1867.[8] Professor Pierre Denonvilliers reminded the assembly of the opposition of the Public Instruction Council, over which he presided at the time: women’s entrance into medicine was viewed as contrary both to morals and to social conditions. Jules Béhier, professor of clinical medicine, declared that "women, being considered as legal minors from the moment they marry, cannot be held personally liable for anything; consequently, adopting Miss Putnam could entail serious complications." [9]

In the report on this session, Dean Wurtz is the only one mentioned as having defended Putnam’s case: he underlined that the law said nothing on the question and that very recently the Minister had allowed a woman, Madeleine Brès, to matriculate in medicine, under the condition that she obtained the two baccalaureates. Despite his important position, Wurtz was unable to obtain Mary Putnam’s acceptance: the professors voted against the young pharmacist’s request. Wurtz informed Duruy, who then presented the request to Princess Eugénie. She convened a council of ministers over which she presided herself. In the meantime, Mary Putnam was able to rally a few students to her cause; in the presence of a chaperone, naturally, they shared with her the classes they were allowed to attend. [10] At the end of the academic year, under the advice of Wurtz, and contrary to what was normally done (matriculation requests had to be validated first by the Faculty, then by the Minister), she directly solicited the Minister, who she knew was supportive of her cause. On July 23, 1871, Mary Putnam became the second woman to receive a medical degree from the Faculté de médecine de Paris, after Elizabeth Garrett (1870). She addressed the first dedication in her thesis to Wurtz, though she did not know his identity at the time: "To the professor whose name I am unaware of, who was the only one to vote in favor of my admission to the École, thereby protesting against the exclusion of women from higher education." [11]

Madeleine Brès

Madeleine Brès (1839-1925), the first French woman allowed to undertake medical studies at the Faculté de médecine, defended her doctorate in 1875 and graduated "summa cum laude". She was dean Wurtz’s first female student: for 7 years, she worked in his chemistry laboratory. 

Among others, Brès dedicated her thesis to Broca, who had played an important role for her five years earlier. In 1870, during the siege of Paris and more particularly during the Commune and the Bloody Week, Madeleine Brès had worked as an intern at the Hôpital de la Pitié de Paris, substituting for Paul Broca who had himself suggested her and appointed her as a temporary intern. Broca recalled:

"Mrs. Brès joined my department in 1869 as a probationary student. In September 1870, several interns having been called to military hospitals, temporary interns had to be appointed. Under my recommendation, Mrs. Brès was designated as a temporary intern. In this capacity, during the two sieges of Paris and until the month of July 1871, she performed her duty with an exactitude that was not even hindered by the bombing of the hospital. Her work has always proved very satisfactory and her behavior faultless. Mrs. Brès was conspicuous for her zeal, her dedication and her impeccable attitude. She proved particularly helpful during the last insurrection." [12]

After this summary of the events, Broca went on to compliment Mrs. Brès further on her availability and her commitment and also on her qualities as a physician. Jules Gavarret, Constant Sappey, Paul Lorain and Charles Adolphe Wurtz also wrote in praise of her in a joint report:

"We are pleased to declare that Mrs. Brès, through her impeccable behavior, her hard work and her zeal in the hospital, gained the respect of all the students she had to interact with, and justified the opening of our courses to other female students." [13]

At the beginning of the 1871 academic year, she requested permission to take the externship and internship examinations. The director of the Assistance publique, despite the petitions and demonstrations in her favor, rejected her request with the following explanation: "Perhaps if it had been for you alone…" [14]

The point was therefore not to create any precedent. After this rebuttal, female students launched several petitions to obtain the same rights to examinations and diplomas as male students. At last, in 1881, the Conseil de surveillance de l'administration de l'Assistance publique finally convened to solve the question of opening externships to women; that of internship was similarly addressed in 1885.

Men and women physicians

Among the professors at the Faculté de médecine, some proved ardent supporters of the right of women to become physicians, such as Wurtz, Sappey, Broca, Landouzy, Verneuil. Others on the contrary long opposed the idea: Béhier, Denonvilliers, Trelat, Moutard-Martin, Hardy [15]. Others still had not so clear-cut an opinion: Vulpian, Gosselin and Charcot, for instance. Charcot is particularly interesting in that his point of view was typical of his time. The report on Caroline Schultze’s thesis defense in 1888, in front of a jury presided by Charcot, shows that a professor could sign a petition in favor of women’s access to internship, and at the same time be persuaded that women should not practice medicine. Reading the report, one understands why Schultze forgot to mention him when dedicating her work. [16] Charcot indeed used the argument of the "nature" of women. Because of their "nature" women lack the physical strength a physician needs to lift patients. The physical "nature" of women also makes them particularly weak for one week a month during menstruation. How can a woman take care of somebody else when she should be taking care of herself? Their esthetic "nature" is yet another obstacle. Women are "by nature" beautiful and delicate creatures in complete contrast with the coarse bodies they might have to treat. The "natural sensitivity" of women is a third obstacle. Seeing blood, dissected bodies or filth profoundly repels them… Finally, nature prevents women from having "the roles they want to play" because of a fourth, psychological obstacle: their extremely proud, ambitious disposition. "Never do they wish to play a mere second role" when they want to take men’s places. Otherwise, wouldn’t they be satisfied with being nurses or midwives? The esthetic and physical traits of women were the main argument used by all those who opposed the admission of women, be they professors or journalists. But it was not only men: women themselves adhered to the concept of a specifically feminine "nature". Mrs. Gaël, whose real name was Augustine Girault, published in 1868 La femme médecin (The Woman Physician)[17]. Although defending the right of women to become physicians, the author nevertheless reminded the readers that, due to the "nature" of women, she initially was of a different mind. Defining the "feminine nature" in exactly the same way as the opponents to the idea of women doctors, the author tried to demonstrate that women may become physicians precisely thanks to their feminine "nature". Gaël explained that, because it is in the nature of women to gestate and to educate children, the vocation of women is to heal; this can be witnessed in certain midwives, nuns or even ordinary mothers. However, the author’s reasoning was going backwards and rejoined that of Charcot. Charcot’s argument was also founded on notions of ambition and exception. In Charcot’s view, only a few exceptional women could enroll at the École de médecine. And Charcot was entitled to believing in exceptions, as women medical students were no more than a hundred at the end of the 1880s. Mrs. Gaël also adhered to the notion of "exceptional women". She admitted that a physician’s career was more demanding than the career of a midwife, and subsequently added that if some women were destined to practice medicine, they could only be exceptions. "That these special vocations should find an outlet (…) is in our eyes perfectly fair and rational (…)".

Postcard, ca. 1900

Stereotypes about women doctors

Scientific and medical journals did publish articles concerning women doctors, but these mostly focused on the situation abroad. [18] Female students in France were never mentioned. Theoretical questions were raised, but the actual French situation was not even alluded to. When Elizabeth Garrett became the first woman to defend her thesis, the event received no comment whatsoever, apart from the following line: "The Faculté de médecine de Paris has just granted Miss Garrett a medical degree"[19]. The few later mentions of the event appeared in the "miscellaneous" column. [20] But the press and various writings surrounding it allow one to see how the stereotype of the woman-doctor was created.

"(…) The accoutrement (blood-stained overalls), the appalling rooms, the human body parts and remains, the hard work contrast most crudely with feminine curves. (…) These young women lose the graciousness, the gentleness, the charm of their sex. They are neither women nor men." [21]

Then came the physical nature of women:

"And when they are pregnant, how will they get close to their patients with their swollen bellies ?" [22]

Both the study and the practice of medicine required masculine qualities:

"In order to be a physician one needs a sharp and open mind, a solid and varied education, a serious and strong character, a great deal of self-control, a mix of benignity and stamina, a complete command over one’s feelings, moral vigor and, when necessary, muscular strength. (…) Isn’t feminine nature just the opposite?" [23]

Le Journal de médecine et de chirurgie pratique resorted to social morals:

"Medical journals keep arguing about women doctors (…). Although we believe, as most of our colleagues do, that women should not practice the medical profession, we have reasons of our own. Some say that women are not cut out for hard, repugnant medical studies; their sensitivity, greater than that of men, would prevent them from undertaking such studies, and their intelligence would not be comprehensive enough (…) But this is not true, as experience has proved. (…) What objection have we got left? The only truly serious one. (…) Working as a doctor is absolutely incompatible with a woman’s life."

"Women doctors will renounce marriage; so be it! They will silence their hearts, their senses (…) stifle their instincts (…) they will not be women any longer (…) their moral beings will have undergone a complete transformation (…) Their physical beings will remain." [24]

In June 1875:

"Women cannot seriously pursue medical careers (…) unless they stop being women: due to physiological laws, women doctors are ambiguous, hermaphrodite or sexless creatures, monsters at any rate. Let those who fancy such a distinction try to acquire it." [25]

The Gazette hebdomadaire de médecine et de chirurgie referred to "androgynous monsters". [26]

Little by little, the fear of female competition dominated the debate.

For fear that women doctors might believe the contrary, the Journal de médecine et de chirurgie pratique specified: "Let us add that it seems obvious that in France women would be exposed to utter failure concerning the final outcome." [27]

In 1884, at the time of the controversy surrounding women's admission to internship, Manouvrier, a journalist at the Revue rose, a journal that publicly supported the admission of women, evoked the competition feared by opponents. "They (the opponents) would say that letting women acquire as much or more competence as male doctors in delivering babies and in female or children’s diseases, good sources of profit that anyone would be sorry to lose, would endanger the corporation." [28]

The sentence from the Gazette hebdomadaire de médecine et de chirurgie pratique called for no appeal. Dechambre, who saw through Duruy’s project to open a medical school for women, who would then be appointed to medical posts in the colonies, fulminated.

"Today (…) we find a former Minister of Public Instruction who is starting to recruit them for the medical profession. (…) The final aim is to push women into amphitheatres and hospitals and to make doctors out of them, no less. The project was initially conceived of by a most respectable lady (Princess Eugénie) for Turkish women, but it is now being extended to Algerian women, and will soon be extended to the whole world. (…)

Although the scope of the project is limited and the school will not issue medical degrees, women will take their degrees at the University, and they will be able to practice the medical profession anywhere, not in colonized countries only. (…) There is no doubt that this first step will lead to the generalization in the fair sex of both the study and the practice of medicine.

(…) One might however, in a pinch, conceive of the temporary usefulness of women doctors in these countries; but we cannot conceive of such a need ever being felt in France." [29]

The students’ opinions

History has retained part of Sorrel-Dejerine’s testimony according to which female students were systematically booed by their male counterparts. [30] Before entering the amphitheatre, the female students had to wait for the professor in the cloakroom. They had to sit in the first row, under the protection of the professor. In spite of this precaution, they were reportedly booed and insulted. One day, as they were tired of waiting for the professor before entering the amphitheatre, they decided they would go in by themselves and that they would sit, not in the first row, but on the benches among the male students. This unexpected move left the male students open-mouthed and put an end to their jokes. [31] Even if the 1884 petition against internship for women emanated from ninety male interns, the mocking and aggressive attitude seems to have been far from universal.

"We want today not a slightly better educated female companion, but an equal, and we give women all the resources that so far were our exclusive privilege so that they might actually become our equals. (…) We have reason to believe that the first cause of the general inferiority of women’s aptitudes compared to men’s is the difference in education. (…) Of the female students currently in our school, not one has incurred the slightest reproach on her behavior; their attitude, be it in the hospital, the amphitheatre or the ward, has inspired nothing but respect and admiration". [32]

The same was true of the Faculté de droit.

"At the end of the first year classes, Mr. Colmet de Santerre, professor of civil law, addressing the students, declared almost in these words: ‘We hesitated before granting Miss Bilcescu permission to attend the lectures, for fear we might have to police the amphitheatres; but this young woman, whose assiduity and behavior have been exemplary, forced our esteem; you have respected her like a sister, and we thank you for it’. These words were covered by a thunder of applause." [33]

These testimonies tend to prove that students were more open to women entering the university than professors were. [34] Female students themselves observed that their male counterparts accepted them. Putnam for instance mentioned in her correspondence the complicity of the male students when it came to taking her examinations. Numerous female students also dedicated their dissertations – in a sometimes grandiloquent manner – to supportive males.

Matilda Ayrton, for example, dedicated her thesis: "To the students who, since 1871, have repeatedly made me see that the words "Liberté, Égalité, Fraternité" are not merely written on the walls but are the very spirit of our school." [35]

Thus, out of the 28 women who defended their dissertations between 1870 and 1884, very few omitted to write a few words on the welcome they received, as a prefatory dedication or in the text of their work, usually at the end of the introduction. One of the means of support that cannot be denied, because it was mandatory, was that of the student’s husband when she was married, or that of her father otherwise. [36]

Militant women doctors

"The conclusion of this dissertation, obviously, is that the second half of the 19th century was marked by a general movement towards the intellectual and professional emancipation of women. All the civilized nations gave a number of women the opportunity to study and practice the medical sciences. The first women to fight for their intellectual and professional emancipation, wherever they were, had to overcome all sorts of difficulties; but nowhere, at least up to now, have their victories been negated." [37]

The conclusion of Schultze’s dissertation on women’s history mentions female medical students’ involvement in social and political struggles.

Indeed, some of these students fully adhered to the egalitarian claims of feminists – as can be seen through the lives of Garrett and Putnam. Garrett held meetings in favor of women’s suffrage. [38] In 1908, she was elected mayor of Aldeburgh, on the Suffolk coast, thus becoming the first woman mayor in England. [39] Mary Putnam became a true socialist at the time of the Paris Commune. Once back in America, she helped Élie Reclus, who after the Commune had taken refuge first in Italy, then in Zurich, to go to the United States (1876). [40]Among the women from the École de médecine de Paris, one should also mention Sophie Ananief, Kropotkin’s wife, who left Wurtz’s chemistry laboratory in 1882 before defending her doctoral dissertation in order to join her husband, who was detained in Claivaux. [41]

However, other female students, in particular French students, eschewed feminism; this was the case of Madeleine Brès, for instance, who did not want to be considered a feminist. Between 1870 and 1884, thirteen female students’ dissertations out of twenty-eight were written on questions in relation to deliveries, children or women. Five out of the seven French women doctors wrote a dissertation on one of these so-called feminine subjects. In the controversy on women-doctors, unanimity was found when the patients were mentioned. A large majority of those who were in favor of women doctors thought women should be educated in medicine exclusively to take care of children’s and women’s diseases. Some women doctors would have liked to be doctors for women. Mrs. Brès, after her PhD, opened a nursery and gave lectures on children’s and women’s hygiene. In that respect, the first sentence in her dissertation is particularly telling: "My prime intention was to devote myself fully to treating women’s and children’s diseases."[42]

The introduction of Catherine Ribard’s dissertation on the drainage of the eye, which she defended in 1876, is quite revealing as well in this respect :

"When I started studying medicine, I decided that I would later devote myself exclusively to treating women’s and children’s diseases. (…) But during my stay in Paris hospitals, I soon realized that eye diseases frequently affected children."[43]