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NINETEENTH CENTURY MEDICAL WOMEN IN FICTION

BY
Harriet Anne Squier, M.D.

A THESIS

Submitted to
Michigan State University
in partial fulfillment of the requirements

for the degree of

MASTER OF ARTS

Interdepartmental Program in Health and Humanities

1994

ABSTRACT

NINETEENTH CENTURY MEDICAL WOMEN IN FICTION

by

Harriet Anne Squier, M.D.

Nineteenth century fiction about women physicians reveals
a world in which women physicians' careers are strongly
influenced by social pressures and professional identity. The
fictional women physicians who choose to leave medicine strive
to fit into a social context in which there are strong norms
for the ideal woman, and in which marriage or family has more
social and personal value than does the practice of medicine.
The fictional women. physicians who continue to jpractice
medicine do so at great emotional cost, yet find sustenance
and fulfillment in the professional aspects of their lives.
These works illustrate themes and issues that are still

pertinent for women physicians today.

Copyright by
HARRIET ANNE SQUIER

1994

ACKNOWLEDGMENTS

I would like to thank my thesis committee for their assistance
and support. Judith Stoddart, Darlene Clark Hine, and Howard
Brody gently guided my work, provided expert criticism, and
acted as mentors and role models. It is truly an honor to

have worked with them.

iv

Introduction . .

Chapter One - Medical Women in Social Context .

Chapter Two - Medical Women in Professional Context

Conclusion . . .

List of References

TABLE OF CONTENTS

21

44

47

INTRODUCTION

In the 1966's, American medicine saw a large influx of
women into the profession. At that time in medical history,
specialization had replaced the family doctor, and science,
rather than the relationship between doctor and patient, was
the center of "good" medical practice. In the 1960's and
1970's patients became disenchanted with impersonal medical
care and a few factions within the medical profession agitated
for alternatives to the traditional biomedical, specialty view
of medical practice.

Now, in the mid-1990's women continue to enter the
medical profession in large numbers, and comprise half the
enrollment of ”many medical schools. At the same time,
financial incentives as well as a redefinition of the doctor-
patient relationship have started to move the practice of
medicine toward a more patient-centered, primary care oriented
profession. Society continues to be vocal about the need for
patient autonomy and shared power between doctors and
patients. Many patients are firm in their acceptance of women
physicians and in their expectations about how women should

practice medicine. Many patients expect, and even demand,

1

2

that women physicians practice medicine differently than men,
believing that women physicians are better communicators and
are more caring than men. Recent research corroborates
patients' beliefs that many women physicians do conduct their
work differently than their male colleagues. These studies
show that female physicians spend more time with patients, are
more psychosocially oriented, and are more patient centered
than male physicians. In addition, women physicians have more
limited practices in terms of hours worked and diversity of
medical problems treated than do male physicians. They are
accused of fewer ethics violations than men, and are more
likely to be certified and to attend educational meetings than
are their male counterparts.‘ It seems clear that current
women physicians question traditional, paternalistic, notions
of the doctor-patient relationship, and strive to develop a
medical practice that is congruent with their and their
patients' values. These values include patient-centeredness,
a high quality of care, and shared power within the doctor-
patient relationship.

As patient demand for women physicians grows, women
physicians face new challenges. They must make personal
choices about the balance of family and profession, and
professional choices about the way they practice medicine and
how they conform with professional norms of practice.
Although women physicians today may feel that they walk
uncharted territory, devising new ways to practice medicine

and to balance their lives, this is not the first time in

3

history that women physicians have had to define who and what
they want to be, or the first time that women physicians have
experienced change within the profession. Although women have
practiced medicine in small numbers throughout the twentieth
century, comprising about 5% of all physicians until the
1960's, it was in the nineteenth century that the first women
gained access to formal medical education. After the first
woman graduated from medical school in 1847, the doors to
American medical education opened to women. By 1910, over
9,000 women physicians were practicing medicine across the
country.‘2 These early women physicians faced many obstacles,
and. defined. themselves according’ to the. goals of their
profession and the beliefs of society. Perhaps learning how
they saw themselves and how they believed medicine should fit
into their lives would help current women physicians gain
insights into similar issues in their lives.

Although. much research. has been done on nineteenth
century women physicians, our view of these women's lives
through historical research can be a confusing and
contradictory patchwork. These women physicians are portrayed
variousLy as feminine caregivers, vehement feminists,
scientists, and. women who ‘manage home and career
simultaneously.3 A closer, more intimate look at how some
nineteenth century women physicians made choices in their own
personal and professional lives, in other words, how they
chose to define themselves as both women and physicians, may

begin to shed light on complex issues in the lives of current

women physicians.

In order to understand nineteenth century women
physicians we might consult their personal records, diaries,
or autobiographies. For instance, in Harriot Hunt's Glances
ang_glimp§§§, published in 1857, we do get some sense of what
it must have been like to stand in her shoes as she practiced
medicine, sought formal medical education, and joined the
women's movement in mid-century;‘ Similarly, Elizabeth
Blackwell's autobiography is a vivid account of her
experiences in medical training, both in the United States and
Europe; in her medical practice; and in the establishment of
her medical school in New York City.5

What doesn't come through clearly in these works is a
sense of what sacrifices these women made to become
physicians, or exactly how they defined the ideal woman
physician, the ideal practice, or the ideal relationship with
patients. We are not sure how they balanced their personal
and professional lives; we know their experiences within their
profession, but little about their home life» In addition, we
do not know if other women physicians were at all like either
Hunt or Blackwell, whose approaches to practice and politics
differed dramatically.

Several fictional works from the nineteenth century
provide us with a close look at women physicians and the
patients they treat. These works go far beyond other sources
of nineteenth century information, not in literal fact, but in

the description of what certain kinds of women doctors were

5

like, and what interactions they had with certain kinds of
patients. These stories reflect for us what the issues were
at the time for the authors and their readers. While we
wouldn't want to say these fictional works necessarily
represent all nineteenth century women physicians, we can say
that they give us the kind of broad, detailed and plausible
information which we have lacked in more traditional
historical sources. The central focus of all these fictional
works about women.physicians is invariably what it means to be
a woman doctor, what life is like for women physicians, and
how women physicians balance their work with their private
lives. These topics are precisely what we seek to
investigate, and what is most elusive in other sources of
historical information.

Because fiction is not like other historical sources,
though, we should not expect to assess it for factual
accuracy. Yet, it does contain truth. As one author points
out, "there are several kinds of truth, and the truth of
literature is not necessarily the truth of science."6 This
truth can involve the emotions, through the reproduction of
emotional responses to specific events, and involves moral
truth, which discovers and affirms the basic essence of human
existence, and is the "highest kind of truth."7 Fiction,
then, deals less with the factual happenings in a person's
life than with their emotional responses to them. We can see
that for women physicians who struggle with their place in.the

world today, nineteenth century fiction about women doctors

6
should provide an excellent resource.

Examination of these works will show that the women
physician characters in nineteenth century fiction practiced
medicine only at a great personal cost. Some of the women
physician characters choose to leave the practice of medicine
rather than face societal disapproval. For these women
doctors, the importance of family and home outweighed that of
medicine. For the group of women physician characters who
choose to continue to practice medicine, professional identity
helped to offset societal disapproval. Stubbornness,
professional competence, and altruism helped these women
physicians to succeed in their careers. It was ‘their
profession, rather than traditional, womanly roles, which
provided them with sustenance and fulfillment.

The seven works of fiction discussed in this paper
represent the most extensive compilation of American
nineteenth century fiction about women physicians to date.
The four novels used in this essay were found through various
references in secondary sources, both from the nineteenth and
twentieth centuries. Poole's Guide as well as index searches
of several nineteenth century magazines were used to find the
three short stories.8 .Although the authors of these stories
are not well known to twentieth century readers, their works
add an interesting counterpoint to the more famous novels. .An
additional novel, Helen Brent, M.D., published in 1892, does
exist, but is out of print, and regrettably could not be

obtained for this analysis.

7

These stories are both dated in the extremity of social
norms at the time, as well as modern in the conflicts and
debates of the women physicians they depict. Many of these
women physician characters are especially competent in their
work. And several challenge both society and medicine to
create the reforms in society that we are only beginning to
realize today. These stories are especially pertinent for
women physicians today.

We will look at the fiction in terms of those who failed
as physicians, and those who succeeded, examining how the
social and professional context influenced each path. We will
conclude with a discussion about how the insights we gain from
these fictional works influence how we look at women in

medicine today.

CHAPTER ONE

Medical Women in Social Context

Although medical women today find the balance between
work and home difficult, the situation was clearly worse for
nineteenth century women, for whom social norms were far
narrower. For instance, in 1847, when Elizabeth Blackwell,
the first formally educated woman physician, graduated from
medical school, it was believed that men were designed to fill
the public role of work, and women were meant for the private
sphere of the home. Thus any kind of work outside the home,
especially for middle and upper class women, was effectively
prohibited.

In the mid-nineteenth century, women were thought to be
the opposite of men - private, domestic, and nurturing. As
one author notes, "women were now seen as guardians of older
values in the new era of harsh competition and worker
exploitation."9 .A certain kind of woman, one who could best
meet the demands of mother and caretaker of the home, was
given high value in society. This ideal woman was nurturing,
passive, emotional, cultured, demure, broadly, though
superficially, educated, attractive, modest and pure.10
Coupled with societal needs for separate roles for men and
women grew the concept that women and men were essentially
different from one another. It was believed that women and

men possessed entirely different natures, abilities, and

8

characteristics.

In parallel with these roles and beliefs grew the theory
that women were biologically destined and ordained to fit the
role opposite of that of men. Women must remain at home and
tend to a family because they were too weak, delicate,
emotional, and debilitated from menstruation and childbirth to
do anything else."

To much of Victorian society in mid-century, the idea
that women either could, or would want to, become physicians
was shocking, disruptive, and illogical. It is not surprising
that the opposition to women's entrance into medicine was
vocal and heated. For many reasons, the practice of medicine
by women seemed immoral. Some critics felt that women were
created by God to tend the home, and that it would be sinful
for women to work in any other setting.‘2 Others felt that
the subject matter of medicine, dealing with vulgar and
intimate bodily functions, should be avoided by "pure minded"
women.13 Women physicians, whether married or single, would
also be immoral for neglecting their family responsibilities
in order to conduct their medical careers.“

The physical limitations of women were also a major
argument against women's education. It was believed that
women lacked the strength and fortitude to withstand the long
hours and rigorous travel in bad weather necessary in any
medical practice.” Menstruation was thought to cause
physical and mental weakness.16 Education was thought to

drain vital energy away from the female organs, effectively

10

"unsexing" a woman.17

Beyond these arguments was the belief that even if women
did obtain an education equivalent to that of men, their
essential difference from men made them particularly unsuited
to the practice of medicine. It was thought that a woman
possessed "overflowing sympathy" which clouded her ability to
reason. Her suggestiveness, acute perception, and intuition
allowed her more creativity than men, but got in the way of
the medical tasks of observation, induction, and careful
analysis. Her impulsiveness caused her to jump 'to conclusions
prematurely.l8

While the portrayals of women physicians in fiction are
shaped.by these societal expectations, they are not limited.by
them. The fact that women did become physicians, the fact
that these authors could envision women physicians as
sympathetic characters, shows that regardless of the doubts
about the suitability of women for the practice of medicine,
there were elements of the ideal.woman that coincided with the
qualities needed to become a doctor. Whether or not these
shared characteristics would be enough to support women
physicians in society and within the profession is a question
raised by the nineteenth century fiction in which women
physicians choose to leave their profession. Although we hear
little today about women physicians deciding to abandon their
profession for alternate occupations or for motherhood, it is
informative ‘to learn just. how' strong' societal pressures

against medical practice for women could be then, to better

11
understand its influence today. For women to choose to leave
medicine, there must have been some degree of pressure,
discomfort, sense of being' out. of place, or attractive
alternatives for such.aidecision to come about" Discussion of
the fictional works about women who abandon their careers will
help illustrate what these issues were. Although the three
works discussed here are not major works and have not been
reprinted or anthologized since their original printing, they
are worth at least a brief look.

In "A Day with Doctor Sarah" by Rebecca Harding Davis,
Doctor Sarah is an activist for women's rights and no longer
practices medicine.19 The story opens as Sarah is introduced
by a wealthy but slightly eccentric socialite to her
fashionable circle of friends. These women are skeptical of
Dr. Sarah because of her radical political views, her flashy
purple gown, her faded appearance which falls short of beauty,
and her profession, which seems scandalous in proper upper
class Victorian society. Although these society women expect
Sarah to be loud and shrill, like other women reformers, she
is actually subdued. Sarah prefers to voice her opinions to
Congress than to wealthy women whom she feels are shallow and
pretentious. The narrator points out to us, though, that
these society women affect change in their own ways,
persuading their husbands and other influential men behind the
scenes, to make necessary political and social changes.

After this uncomfortable meeting, Sarah travels to

Washington, D.C. to meet with Congress and to deliver a

12

speech. On her train ride there she spends time with a former
lover who is a widower with several poorly-kept children, one
of whom is crippled. This child awakens Sarah's latent
motherly and doctorly instincts. The narrator equates
medicine with mothering, saying that some women are born wives
and others are born mothers, and Doctor Sarah is the latter.
When the train.derails and.her former lover is killed, leaving
his children orphans, Sarah chooses to raise them as her own.
This action finally leads Sarah to a feeling of fulfillment in
her life.

In this story, despite their differing social situations,
the women characters are the caretakers of society, working
behind the scenes to improve the world. For Dr. Sarah, the
public role of women's advocate is abandoned for the more
satisfying and ultimately necessary role of mother to several
orphaned children. In a fundamental sense, Harding seems to
say that it is women, not men, who ensure the proper care and
nurturing of children, the family, and perhaps of society
itself. Dr. Sarah, like other women, may fulfill this destiny
through politics, career, or motherhood. Since the care of
these particular children is more immediately gratifying and
essential than her public or medical work, Sarah can best meet
her life goal of caring for the unfortunate by being mother to
these children. In the context of this story, Dr. Sarah's
choice to leave the public world for motherhood is a
fulfillment of her life dream. In no way is it seen as a

failure.

13

Unlike women of today, Dr. Sarah must choose between
medicine, politics, oerotherhood, for combining work and.home
is simply not an option. It is interesting that Davis
distinguishes the work of wifehood from motherhood, claiming
that women often are not good at both jobs. This distinction
opens the possibility of socially acceptable medical careers
for women, for these careers encompass the motherhood aspect
of the ideal woman; caring for patients is similar to caring
for children. For women who do not have their own children,
doctoring is a natural choice. Caring for society is another
possible, though less acceptable, alternative in keeping with
women's natural roles.

While women physicians of the twentieth century may feel
pressured by their patients to be more nurturing and attentive
than their male counterparts, nineteenth century women
physicians in fiction were not necessarily as natural at
caregiving as Dr. Sarah. In the novel, Doctor Breen's
Practice by William Dean Howells, published in 1881,20 Grace
Breen enters medicine because she wants to martyr herself, not
because she has natural mothering instincts.

This woman physician is a beautiful, wealthy, and refined
New'England.woman‘who studies homeopathy after being jilted.by
a lover. When vacationing after completing medical school,
Grace and her mother along with a sickly friend, Mrs. Maynard,
go to the shore of Rhode Island for the summer. While there,
Mrs. Maynard.goes boating, at Grace's insistence, is caught in

an unexpected storm, and contracts pneumonia. Grace blames

14

herself for her patient's illness, and, when Mrs. Maynard
questions her ability to effectively treat her pneumonia,
Grace seriously doubts, not only her abilities as a physician,
but her motivations as well. Reluctantly, Grace consults with
a regular practitioner, Dr. Mulbridge, for advice. When he
refuses to consult with her because his medical society would
ban him from membership for consulting with a homeopath, Grace
turns the case over to him.

During Mrs. Maynard's illness and recovery, Dr. Mulbridge
decides that Grace would make a good helpmate in his work and
proposes marriage to her. In the meantime, Grace falls in
love with Walter Libby, a longtime friend of Mrs. Maynard.
Ultimately, Grace abandons her medical practice and marries
Mr. Libby. In the end, and only with.his encouragement, Grace
does treat the children of his mill workers, although she no
longer calls herself a physician.

Grace Breen's difficulties as a physician begin even
before she enters medical school. What makes Grace ladylike,
attractive, and.the:embodiment.of the nineteenth.century ideal
woman, is what makes her ineffective as a doctor. As a
teenager, Grace was crushed when her lover rejected her and
married her best friend. She suppressed her disappointment
and sought to make herself invulnerable to further pain by
studying’ medicine, which "cost. her more than the ‘usual
suffering that it brings to persons of sensitive nerves," and
which involved work which was "almost insuperably

repugnant."21 Grace would sacrifice her life, her femininity,

15
and her status in society to do good for others.

It is not long, however, before Dr. Breen becomes very
uncomfortable with.the martyr roles She is discomfited by the
embarrassment of men when they realize she is a doctor. She
also confronts the resistance of her patient, as well as other
women, to homeopathy, and to women doctors. These women doubt
the gentleness of her homeopathic remedies, and they see
Grace's career as scandalous, something that no respectable
woman would pursue. Moreover, they have never known a
successful professional woman, and themselves possess none of
the strength of mind or character which such a woman would
have. As opposition to Grace and her therapies mounts, she
begins to doubt herself, too. Since Grace, like other
physicians of the time, believes that a patient must have
faith in his or her physician in order for medical treatment
to work, and since her lack of self confidence influences her
patient, she knows she is doomed to fail as a physician.

Grace's experiences lead her to feel she is "impulsive
and timid and nervous, and everything that I thought I was
not."22 Since she cannot imagine that the practice of
medicine could be anything but unpleasant, Grace is perfectly
willing to leave it and marry Walter Libby. With this
marriage she jplans to ‘travel, enter society, enjoy ‘the
cultural worlds of art and music, and otherwise become an
ideal Victorian upper class woman. Despite the encouragement
of both Dr. Mulbridge and of Walter Libby for her to practice

medicine, she goes as overboard in abandoning her profession

16
as she did in entering it in the first place. When we see
Grace again at the end of the book, she has begun to find a
balance between her need to have enjoyment in life, and her
need to be useful to others. Although she refuses to call
herself a doctor, she does provide some limited care for the
ill children of her husband's mill workers.

We might speculate why Howells chose to make Grace Breen
so emotionally labile. Since he was known as a realist,
perhaps he actually believed that this was an essential
characteristic of all women. Certainly there are no other
particularly rational women in this novel. Alternatively,
Grace Breen's insecurity could be a literary device which
actually challenges the stereotype of the ideal Victorian
woman, undermining the assertion that being an ideal womanwwas
desirable. Since it is the balance between career and
marriage that brings Grace Breen closest to happiness, Howells
may mean that even women who want to be feminine need not
underestimate their capacity for emotional and mental
strength.

While Grace Breen was dramatically influenced by social
pressure, professional insecurity, and emotional lability,
Naomi Thorp in Barnet Phillips' "A Doctor Spoiled," published
in 1862,23 finds that her professional accomplishments do not
substitute for the more rewarding role of ideal woman and
wife. Naomi Thorp is an intelligent and attractive young
woman recently graduated from medical school, who is taking a

summer vacation on the Massachusetts seashore. While there,

17

she literally stumbles across an injured man. on a fishing
pier. After deciding that he is not drunk and is a worthy and
respectable patient for her to treat, she tends to his wounds
and becomes his physician. In the course of treating him, her
patient falls in love with her. By the end of the story,

after much persuasion by her patient, Dr. Thorp decides to
marry him and leave her profession.

"A Doctor “ Spoiled" fits the form of a stereotypical
nineteenth century romance. True to the romance form, Naomi
Thorp is an immensely sympathetic character, beautiful,
charming, intelligent, who has overcome hardship in her youth,
and looks to face continued hardship in her medical practice.
Despite her love and talent for medicine, the narrator leaves
no doubt as to the difficulty of this profession for Naomi.
He says that if she ever were able to develop a busy,
successful practice, "it would be when she was fifty, old and
withered, broken down with toil." The outcome, to fit the
romance form, necessitates that the heroine find a reward for
her hardship by finding a loving husband who will cherish her,
lavish her with attention, and provide her with the luxuries
that she deserves.

Dr. Thorp is a *well educated. practitioner, who is
familiar with the latest books and articles, is knowledgeable
about the ‘most. recent. developments in ‘therapeutics, and
translates German articles about new scientific developments
for another physician. Even more impressive, Naomi's

femininity is undiminished by her medical knowledge. The

18

effect of this femininity, though, in addition to making her
more attractive to her patient, is to make her a less
effective physician. Because she is petite, quietly elegant,
"delicate and pale" with "wonderfully good eyes," she "is
entirely too nice-looking for the professional woman."24 She
is "full of quiet sympathy," and wishes to be "humble and
inconspicuous."” ‘While she is able to "look very severe, and
a trifle hard" as she practices her work, this state is
uncomfortable to her, and she prefers to be pliable and
sympathetic.26 Since nineteenth century medical practice
dictated that the physician be authoritative and definitive in
order to foster the patient's confidence and harness his
natural abilities to heal, Naomi is unable to find a
comfortable balance between her professional demeanor and her
feminine sensibilities. Finally, she chooses the feminine
role as more likely to provide her with happiness.

For the women characters who chose to leave medicine, the
tensions between their roles as ideal women and their
motivations tijracti e medicine are very clearu .All three of
these women physician characters are very much aware of their
place in society and struggle with either defending or
maintaining it. In addition, they want to uphold the moral
standards of society by doing right by others, but are not
always sure that.their’means actually do accomplish.good~ For
all the women physician characters who leave medicine, moral
duty is more closely aligned with the mothering role than with

the doctoring role. Motherhood (or wifehood) allows them to

19
continue to serve others (their husband and/or children) while
retaining the respectability they deserve. Their powers are
heightened when they no longer have to protest against
societal expectations.

Thus, it is easy to see how the tensions inherent in job
and social roles for these Victorian women physicians in
fiction influence their abilities and decisions to practice
medicine. The authors of these stories are overall very
sympathetic to their women physician characters. We like
these women and find them feminine and attractive. Still,
though, we do not end up*with.a real appreciation.that medical
practice for nineteenth century women was an attractive option
on the basis of these stories. Just like the essayists
warned, in order for a women to fulfill her real destiny in
life, in order for her to be an ideal woman, medical practice
is an impossibility.

Although only a minority of persons in America today
would claim that women should not practice medicine, these
stories are helpful to us in that they emphasize how strong
societal pressures regarding women's behavior can be. These
pressures can dramatically change the course of women
physicians' lives. The societal demand that women physicians
somehow change, soften, become maternal, and leave their jobs
for the more important work of motherhood and/or wifehood,
while taking different form today, has not really been.a1tered
much in the course of 100 years. We as readers may be

disturbed at the ease with which these women characters left

20

their profession, but are not surprised that they had many
pressures against them to do so. ‘Their need to define who and
what they want to be is important for all women considering
medicine as a career. For these nineteenth century women in
fiction, though, it is conformity with society's norms that
creates a strong and lasting sense of identity, rather than
conformity with the medical profession's norms.

The women characters in fiction that choose to remain in
medical practice face similar pressures, yet come to very
different conclusions about the importance of medicine in
their lives. The professional identities they develop provide
sustaining power which the womenwwe have already discussed are

never able to find.

CHAPTER 2

Medical Women in Professional Context

Part.of the reason.some of the women physician characters
could so easily leave the practice of medicine may stem from
the fact that medical education was far less demanding in the
nineteenth century than it is today. At that time, the
medical curriculum consisted of two or three years of
classroom learning, usually without the need of an
undergraduate degree. Thus, these women may have had less
drive to remain in the profession because there had been less
time committed to the process of education.

Other aspects of medical practice, such as the
professionalization process, were also different for women
physicians in the nineteenth century than they are now. The
characteristics of a profession, such as emphasis on public
service, high social status and.autonomy of its practitioners,
a hierarchical organizational structure, and an exclusive and
elaborate educational process, were not completely developed
in medicine in the nineteenth century.27 For women
interested in medical careers in the late nineteenth century,
the .American ,IMedical Association and other medical
organizations were of no help in the achievement of
professional status, for, usually, they did not admit women
physicians to their ranks. .And, as for her male counterparts,
the title of Doctor was not a guarantee that.a woman physician

would gain social stature unless she was born into it. Thus

21

22
for women physicians, claims of altruism and solid
professional credentials were the only means by which a woman
might achieve a professional status equal to that of respected
male physicians.

The quality of a medical practitioner was influenced by
how the physician related to and kept up with the dramatic
transition in medical therapeutics in the nineteenth
century.28 This transformation was not simply a change from
humoral medicine to scientific rationalism, but was a
fundamental change in the perception of the body and how it
functioned. In the early nineteenth century, physicians
believed that every part of the body was related to every
other; health or illness were general states of the total
organism. In this system, the body in health was a balance of
intake and outgo. An imbalance of the system meant disease.
Medical therapeutics were aimed at creating visible symptoms
which.represented.the physician's attempt.to maintain the body
in equilibrium.

Until the mid-nineteenth century, many therapeutics were
harsh; bloodletting, cathartics, and emetics, for instance,
were used in heroic proportions, with the belief that the
obvious results they caused could counteract the disease
process resulting from bodily imbalances. Even late in the
century, these harsh remedies were used to various degrees by
individual physicians and in particular parts of the country.

Homeopathy, and probably other medical sects, gained

popularity for they sought to :reestablish the necessary

23
balance of health without toxic and uncomfortable medications.
These sects still saw the body as a system in equilibrium.
They differed from regular medicine by using milder remedies
such as highly diluted medications, water treatment, botanical
treatment, and others, to reestablish equilibrium.

In the middle third of the century, new medical
developments prOVided evidence that many diseases, such as
smallpox and other infections, were the result of specific
causes, rather than a reaction to one's environment of other
disruption of homeostasis. In response to this new
information, physicians recognized that the natural course of
many diseases led to spontaneous cure. They now used their
traditional remedies, though in lower doses, to support the
body in its natural progress toward health. Drugs were
combined with an increasing emphasis on dietary and
environmental regimens to strengthen the body. Moreover, the
body was felt to possess a vital power which propelled the
healing process. Physicians believed that they could support
this vital power through various means, such as strengthening
agents like alcohol, hygiene, and the patient's own belief in
the doctor, to encourage and speed healing.

By the end of the century, when most of our fictional
works were written, medical therapeutics had become less an
attempt to maintain the body's homeostasis and more a
systematic observation and characterization of illness and the
natural course of disease. Physicians recognized that they

often were able to predict the course of disease without being

24

able to alter or cure it. Aside from new developments in
surgery, physicians in the late nineteenth century and early
twentieth century sometimes questioned whether therapeutics
had any role in medicine at all.29

Since we know that physicians' moral and emotional
strength as well as physical and scientific powers were used
to effect healing, and since Victorian society already defined
women as more moral, spiritual, and emotional than men, it was
this reasoning in part by which women justified their ability
and right to study medicine at this time in history.30 As
Regina Markell Morantz has said, women physicians "made
Victorian ideology yield to them and used these notions to
justify seeking medical education."31

How the transformation in medical thinking affected the
practice of women physicians is not clear. There is some
evidence that women physicians did differ from their male
colleagues in their use of therapies.32 At the very least,
women physicians were influenced by the therapeutic
transformation just as men were influenced. By keeping
current with the changes in knowledge and therapeutics, as
well as responding to the moral and medical needs of those
less fortunate, women physicians could validate their
professional standing. For the women physicians in literature
who choose to remain in the profession, it is this
professional identity that gives them the strength to continue
to practice medicine.

It is significant that for the women characters discussed

25

previously who left medicine, medical therapeutics was not
really a major theme in the literary works. Although one of
the women was a homeopath (for all we know,‘Dr. Sarah could
have been, too), this fact is significant only because a high
percentage of women physicians, especially in the northeast,
were homeopaths.33 We get no sense from the fiction about
women who abandoned medicine that these women entered the
dispute between allopathy and homeopathy with any vigor or
that they chose their sect because of any particular passion
about it. Instead, homeopathy for the authors was perhaps
chosen to impart on their characters a higher social standing,
for the wealthy, especially wealthy women, were the most
ardent supporters and users of homeopathy.34

The women characters who stay in medicine are much more
articulate about their political and scientific stance within
their profession. Even in the earliest work, science is
looked upon as a positive force in its own right. These women
characters gain support from the value of science, as well as
from the social importance of their jobs. All four of the
women.characters who stay in medical practice seem.to practice
at the cutting edge of their profession.

The first work of fiction with a female physician as
protagonist.was "The Battle and.Triumph.of Dr. Susan," written
by Fitz-Hugh Ludlow and published in 1863.” Dr. Susan is a
masculine-appearing woman whijractices hydropathy (treatment
with water) and homeopathy (treatment with infinitesimal

dosing) in a water-cure establishment in New York State. She

26

is respected by her colleagues as the best doctor among them
for the management of complicated illnesses. She cures a
young businessman, Mr. Remy, of typhus, and in the process
falls in love with him. Unknown to Dr. Susan, Remy has fallen
in love with Dr. Susan's beautiful and womanly friend, Helen
Talfourd. When Dr. Susan attempts to tell Mr. Remy she loves
him she inadvertently discovers his affection for Helen.
Susan is angry, hurt, and utterly devastated. When Helen
contracts typhus, Dr. Susan, still stinging from her
rejection, must decide whether or not she wishes to, or is
emotionally able to treat Helen. Here Dr. Susan's desire to
find love conflicts with her commitment to heal the sick. In
the end, Dr. Susan.decides that despite the personal cost, she
will care for Helen. At the end of the story, as her now
healthy patients travel away to marital happiness, Dr. Susan
is left alone with only her work for solace.

Mr. Remy and Helen Talfourd are cured, not by hydropathy
or homeopathy, but through Dr. Susan's "patient skill and
science."36 Dr. Susan is "a masculine soul run by freak into
the feminine mould," who possesses "an enslaving ower" which
she uses to heal.37 To the narrator, it is the fact that Dr.
Susan is so manly which gives her the ability to be an
effective physician. Only a man, the narrator implies, could
have the mental ability and sheer power of will that she
possesses, and which is necessary for her to heal. ‘Water cure
and homeopathy place a distant second to Dr. Susan's mesmeric

talents. "In hydropathic institutions cure of any thing more

27

serious than a toothache takes at the least several years."38
"...Drops of water, homeopathically tinctured,... formed at
Beech-Wold the only medical ally to water' tinctureless
(339)."39 The irony in these descriptions makes it clear that
the narrator holds less faith in the formal medical
classification of his treatment than he does in Dr. Susan's
innate ability to cure. When she finally agrees to treat
Helen Talfourd, Susan "sat holding Helen's hand... Her will
was working at its highest stretch, driving magnetic life from
her powerful being into every vein of the woman...."40
Through these superhuman powers, Susan is able to cure Remy
and Helen. Susan was like "a hollow old ash, broad, gnarled,
and blasted every where except one limb."‘“ Susan's one
positive attribute, the one live limb, was the ability to
heal.

This story provides an excellent example of the
transition in medical thinking described by Rosenberg. In
1863 traditional therapeutics were being questioned, and
physicians were required to call upon other or additional
powers in order to heal. That Dr. Susan is female, although
not an "ideal" or "womanly" female, adds an interesting twist
to this story. The male physician in the story is completely
ineffective compared with Susan. Perhaps it is because her
gender and abilities are mismatched that she has such an
abundance of vital power to impart to her patients. She
necessarily will be unhappy and unfulfilled in this world, and

has found a way to channel the resulting tension and

28

frustration into productive medical work. When she finally
resolves herself to the fact that she will never experience
love as other women do, Susan says "I shall be useful, I shall
be famous perhaps. There is something in this to live for."42
Still, it is not by coincidence that Susan is last seen
standing outdoors in a thicket known only to her, called
Susan's Solitude. Although she will continue to do excellent
medical work, she will necessarily be forced to do it alone.

At the time Dr. Breen's Practice was published in 1881,
Elizabeth Stuart Phelps was already at work on Doctor Zay,
published in 1882.43 Dr. Zaidee Atalanta Lloyd is a
homeopathic physician in rural Maine. Although born and
raised in Maine, she spends much of her early life in the
society circles of large eastern and European cities. After
her mother dies, Zaidee decides to study medicine and to
practice in rura1.Maine, where she feels there is the greatest
need of women physicians by women patients. Dr. Zay develops
a very successful practice. She cares for most of the members
of her community at all hours and in all weather. .After Waldo
Yorke, a young lawyer from Boston traveling in Maine, is
seriously injured, she becomes his doctor» Over the course of
many weeks, as he heals from.his wounds, he falls in love with
her. Dr. Zay resists his affections, for she feels that he
has not the mettle to be married to a woman doctor, and she
has no intention of abandoning her career in. marriage.
Contrary to her expectations, though, Mr. Yorke is a

persistent suitor, and values Dr. Zay's medical work nearly as

29

much as she. He knows that she must practice medicine in
order to be happy, and in order to be herself. He hopes to
provide whatever support he can to her. Finally, like many
rural physicians of her day, she is worn down from her
exhausting work.“ Despite the need for her in Maine, she
ends up agreeing to marry Yorke, presumably to return with him
to Boston and to establish a practice there. This retreat
from rural practice was not uncommon in the late nineteenth
century.“

Dr. Zay is the consummate woman physician. She combines
the:qualities of the nineteenth century ideal woman with those
of the ideal physician. She is as feminine as she is skilled.
Like the ideal nineteenth century woman, she is cultured,
attractive, poised, graceful, and proper. Her tastefully
decorated rooms are scented with flowers. Unlike the ideal
woman, though, her delicate hands are strong and possess the
skill of the most careful of surgeons. Dr. Zay shines when
her patients are well, and worries when they are ill. When
the child of a poor family dies, she mourns it, although no
one else, except its own mother will. When Mr. Yorke
witnesses her grief he perceives that "he had found the woman
in the doctor.“6 She is like a mother to the women and
children.of her community; .And, like children, they depend on
her to help them through their most difficult times.

As a homeopath, Dr. Zay believes that every emotion, as
well as every physical sensation, is a symptom of

physiological imbalance, and therefore is amenable to medical

30
treatment. She researches these symptoms carefully; her
office is lined with bookcases. She discourses intelligently
on a number of scientific subjects. Like the most cultured of
women, though, she also converses on art and opera.

Her presence and authority are well respected in her
town. She is greeted respectfully by men and women alike, and
has a soothing effect on them. For instance, the stagecoach
driver's "pet oath stuck halfway in his throat, and gurgled
away into 'Evenin', Doctor!' as he yielded the narrow road to
the pony, and struggled on with unprecedented meekness into
the silent, frozen village street."47 This ability to heal and
soothe is an intrinsic part of Dr. Zay. Mr. Yorke perceives
that she would be less of a woman if she were not a doctor,
and less of a doctor if she were any less feminine.

For the first time, we see the ideal woman and the ideal
physician united. Although Dr. Zay prefers not to treat men
because it is more difficult to maintain professional decorum
with them, she proves herself competent to do so, and
frequently treats entire families as a matter of routine. She
is a complete physician, able to manage physical as well as
emotional wounds. As she cares for the poor, the ignorant,
and the disadvantaged without complaint and at all times of
day and night, we witness an ethic that is uncommon in
nineteenth century writings about the proper medical practice
for women (or men) physicians.

Probably the most well known novel about a woman

physician is A Countgy Qogtor by Sarah Orne Jewett, published

31

in 1884.48 Nan Prince is an orphaned girl raised in rural
Maine by a well respected widowed physician, Dr. John Leslie.
Dr. Leslie allows Nan to grow up as naturally as possible
without forcing her into any predetermined mold. After
spending her early childhood largely outdoors, Nan becomes
interested in books, including her guardian's medical
textbooks. At age twenty Nan decides to study medicine and
follow in Dr. Leslie's footsteps. She works for two years as
Dr. Leslie's apprentice then attends a women's medical school
in Bostons .After her studies, but before.her work begins, Nan
opens relations with her long-estranged aunt who lives in a
bustling coastal town. During this visit Nan is pursued by a
young' man, George Gerry, who proposes ‘marriage to iher.
Although she is tempted by the offer, she ultimately decides
that she is best suited to be a doctor, not a wife. Despite
offers to study in Europe and to work in prominent city
hospitals in the United states, she finally returns to rural
Maine to work with Dr. Leslie.

Like Naomi Thorp in "A Doctor Spoiled," and like Dr. Zay,
Nan Prince is a well-respected and learned physician. She is
also feminine, cultured, and."well-bred." 'Unlike Naomi or Dr.
Zay, though, Nan is not particularly concerned about her
appearance nor about the seemliness of treating male patients.
Nan lets the patients choose to see her or not; Dr. Leslie, by
assigning Nan to certain patients' cases, ensures that she
will ultimately be accepted in her community. And unlike

Grace Breen, Nan Prince is very comfortable in her role as

32

physician. She and Dr. Leslie spend many hours conversing
about the various idiosyncrasies of local families: how they
react to illness, how they respond to treatments, and how to
handle their cases. The two doctors are secure in their own
judgements about these patients; they use and trust their
intuition and knowledge to make the proper diagnoses. Nan
becomes a woman who "was anything but self-asserting, and she
had no noisy fashion of thrusting herself before the public
gaze, but everybody trusted her who knew'her; she.had the rare
and noble faculty of inspiring confidence."49 It is this very
sort of confidence which the nineteenth century physician
relied upon to effect healing.

Nan learns that "it is resource, and bravery, and being
able to think for one's self, that make a physician worth
anything.”” She borrows from both the new developments in
medical science as well as from old, standard therapies, to
find the best approach for each patient. To be this
comfortable with the vagaries and changes in medical practice,
to be able to sort through old remedies and new claims, Nan
requires a confidence and intuition that is rare, indeed,
among the other fictional women.physicians we have seen. Even
Dr. Zay, who is competent in her practice, relies heavily on
her books of homeopathic testings to determine proper
treatment. Nan Prince, a regular practitioner, chooses among
a number of diagnoses and treatment options. She becomes a
well rounded and competent physician on a par with the best

male physicians.

33

The narrator of’A Country pgcto; makes it clear that this
ability to doctor is not a particularly male or female
attribute. A colleague of Dr. Leslie's suggests that his
medical intuition.may be related to female intuition and that
"the feminine intellect is the higher, and that the great
geniuses of the world have possessed it." In response Dr.
Leslie replies that this gift is neither male nor female, but
"the higher powers of our common humanity.“1 It is a gift
which Nan shares with him, and likewise feels is related only
to her personal makeup, not to her gender. .Although Nan feels
that medicine is a "most womanly and respectable calling,”2
it is so because she, like a few select other women, has a
particular fitness for the work. She believes that whatever
talents a person is born with should be allowed to grow and
flourish, whether they be tending a home or working in a
career.

The one time Nan's confidence in the rightness of her
career choice is shaken is when George Gerry, a young law
clerk who is a favorite of her aunt's, proposes marriage to
her. Both George and Nan see a power struggle in their
relationship. George feels uncomfortable with the power that
emanates from Nan's medical competence and composure. For
instance, when on an outing together they encounter a farmer
with a dislocated shoulder. Nan relocates the shoulder
quickly and with great composure but George becomes queasy
when he hears the bone clunk into place. While Nan does not

feel that her role of physician personally threatens her

34

femininity, George feels that her career is a threat to him.
As the narrator says, because "it is in human nature to
respect power...all his manliness was at stake, and his
natural rights would be degraded and lost, if he could not
show his power to be greater than her own."53 Clearly George
Gerry doesn't feel the way Nan.does about the rightness of her
career.

Nan in turn is caught off guard by her relationship with
George. While she does feel love for him, marriage would
completely disrupt her career plans. For Nan, marriage and
work are not compatible. She doesn't feel she would be able
to commit herself fully enough to either, for "the two cannot
be taken together in a woman's life as in a man's."“ The
relationship with George threatens to take away from her the
career which had become her very nature. It was "an enemy, a
strange power," which made her feel entirely defenseless.”
For Nan, the power of the relationship is a power over her.
In contrast her power as a healer is a means to do good in the
world, to treat the ill and to "be a tonic to the mind and
soul."56 Having her power to do good diminished by anything,
including marriage, would be to ignore not only the talent she
has as a physician, but also the responsibility this talent
carries with it.

A very different novel than the others we have discussed
is The Bostonians, by Henry James, published in 1886.57 This
is a novel about the women's movement in Boston, Massachusetts

in the late nineteenth century. The characters portray various

35
types of people involved in a community of women reformers.
They include an elderly activist, Miss Birdseye; a wealthy,
rigid, humorless reformer, Olive Chancellor; a beautiful,
feminine, malleable public speaker, Verena Tarrant; and Basil
Ransome, a handsome southerner, who loves Verena and strongly
opposes the women's movement.

Dr. Prance, possibly a takeoff on.Jewett's Dr. Prince, is
a minor character in The Bostogians. Dr. Prance is "spare,
dry, hard, without a curve, an inflection or a grace" who
"looked like a boy."58 She is a homeopath who is extremely
scientifically oriented. She is suspected of conducting
scientific research, including dissection, in her living
quarters. She is ambitious, and is motivated to pursue her
studies because "I don't want the gentlemen-doctors to get
ahead of me."” The scientific side of medicine is clearly a
priority for Dr. Prance.

She is impatient.with the women's movement, for she feels
that if women didn't waste their time talking, and did more
working, they might already have their rights. She is
interested in her patients' physiology, but not necessarily
their politics. In the novel she is directly contrasted with
the beautiful, but light weight, Verena, and the idle,
frustrated, idealistic Olive. Instead of valuing material
possessions, supporting the women's movement, or currying the
favor of men, Dr. Prance has thrown herself into a medical
career with as much commitment as any man. Her skepticism of

the women's movement comes from a personal satisfaction with

36
her own choices in life. She seems to believe.that if women
are truly committed to equality, they should be willing to
disregard appearance, public approval, and social standing to
pursue a career. While Dr. Prance is very comfortable with
her role in life, the other women characters either lack the
ability, dedication, or desire to pursue similar careers.

Although we see very little interaction between Dr.
Prance and her" patients, she is attentive to the medical
implications of the physical appearance and emotional state of
people around her. Instead of remarking on Verena's beauty,
she notices that "there was a certain indication of anemia."60
As for Dr. Zay, every complaint or aspect of one's physical
appearance may indicate underlying disease. For Dr. Prance,
the only important things in the world are related to the
practice of medicine.

Dr. Prance feels she has given up nothing to practice
medicine, IHer manly appearance and lack of social graces free
her to pursue a career without the distractions inherent in
conventional social intercourse. We may imply that if the
nineteenth.century'woman truly wanted.equality, she should not
be afraid of becoming just like Dr. Prance.

For Dr. Prance, as for the other practicing' women
physicians in fiction, conformity with public expectations was
less an issue than personal and professional fulfillment.
Clearly, these‘women, in contrast.to the warnings of opponents
to women's education, are not hampered by physical or

emotional weakness, inability to master their profession,

37

immorality, embarrassment. about. bodily functions, or
impulsiveness. In this respect, they are like twentieth
century women physicians, for whom these issues only
occasionally surface. And unlike the women in fiction who
choose to leave their medical careers, these women physicians
are not overly obsessed with their public appearance or with
fitting societal norms. 'That is not to say that their careers
are easy or that the choices they must make in their lives are
without pain.

It is remarkable that these women are very much their own
persons, as different from each other as they are from the
societal norm for the "ideal woman." In this manner, these
authors.question the norms of society, and.the values inherent
in them. The two most masculine women, Dr. Susan and Dr.
Prance, in the earliest and latest of our works, may not fit
societal norms, but that doesn't mean that they don't have
worth to society. Dr. Susan is such.a misfit that her work is
ultimately the only place she can feel at home. Ludlow
suggests that only a very masculine woman can have the mental
powers and control necessary to practice medicine. Although
Helen Talfourd is the model woman here, not Dr. Susan, still
Ludlow allows Susan a measure of dignity in the midst of her
loneliness. If she cannot succeed as a real woman, at least
she is allowed to succeed as a masterful physician.

Henry James uses Dr. Prance as a foil for his other women
characters. While they are all talk and theory, she is all

action, carrying out their theories in very concrete ways.

38

While he seems to say to these women reformers, "Watch out
that you may get what you ask for, and what you ask for is Dr.
Prance," still Dr. Prance is not at all unhappy, just as a man
who is wrapped up in very important work is not unhappy. The
idea that women who work might become just like the men whom
they emulate would not bother Dr. Prance at all. Still, that
was not a notion attractive to women of the nineteenth
century, just as it is not attractive to many women physicians
today. Two authors, Phelps and Jewett, explored how women
could enter professional work without being masculinized.

Phelps' Dr. Zay sees herself as mother to her community.
She embodies both the ideal woman, as she is cultured,
feminine, graceful; and the ideal late-nineteenth century
physician in her science and scholarship. Her scientific
books and rigorous use of data on homeopathic testings provide
her work with structure and validity. She is not hampered by
Dr. Breen's uncertainty about the effectiveness of her
medicine. Instead, Dr. Zay is freed to avoid taking too much
responsibility for the welfare of her patients, for she knows
that she is eminent in.her field, and practices medicine among
the best in the country. Dr. Zay's femininity seems inherent
to her. Her ability to maintain a certain level of culture
and decorum makes her medical treatment more effective; her
social class, above that of her patients, lends her
therapeutics a level of authority that would be lacking if
recommended by anyone less trustworthy and honorable than

herself. How she is able to maintain her femininity,

39

sensitivity, and culture in the Maine wilderness, surrounded
by‘ people: quite unlike Iherself, is not entirely clear.
Apparently she‘was born with.a solid sense of herself, both in
terms of her intelligence and abilities, and in terms of her
female nature. The behavior that she maintains, by being
valued by the society in which she lives, allows Dr. Zay to
have confidence .. in the rightness of her identity and behavior.
She is nurturing and mothering in her medical practice,
because women were supposed to be that way. She is scientific
because good doctors are supposed to be that way. That these
components of this woman physician can coexist so easily in
this character is a tribute to Phelps' understanding of the
virtues of both the private and public aspects of female
Victorian lifec Instead of rejecting all aspects of the Ideal
Woman, Phelps identifies those aspects which give nineteenth
century women stature in society, and which would help women
move ahead as they enter the work place. The qualities of
morality and nurturance used in a professional capacity lead
women physicians not only to be more accepted by society, but
also make them more successful as physicians.

Sarah Orne Jewett, in contrast, feels that the womanly
ideal, and societal strictures against women entering the work
place, should have nothing tOidO‘With her main character. She
feels, instead, that persons are born with innate
personalities and abilities that education or societal
expectations cannot affect without great difficulty. She

feels, instead, that all children should grow up "naturally,"

40

to develop along whatever lines they were destined to. Girls
most often will end up marrying and having families, probably
because that is what they are best at. But some girls, like
Nan Prince, after being allowed to grow up with minimal
fetters, will be destined for other work than motherhood, Nan
investigates the possibilities of love and marriage, but feels
she would have to give up too much of her own nature and
talents, to take this course.

Perhaps the most striking thing about the women
physicians in :nineteenth. century literature 'who stay in
medicine, is how strong and uncompromising they are about the
practice of their profession. They never apologize or feel
guilty for practicing the way they do. .Dr. Susan knows she is
the best physician of the water cure facility. She never
questions why she treats people the way she does; she has
enough clinical skill and knowledge to know it is the best
way. When Dr. Zay treats a woman who is pregnant out of
wedlock, then forces her nearly-drowned lover to marry her,
she knows she is absolutely right in what she does. iMedicine,
for Dr. Zay, encompasses social, as well as physical, ills.
She may be sad when she rejects.Mr. Yorke's marriage proposal,
choosing her career instead, but she never is guilty or
apologetic. She knows that what she does is more important
than marriage. It is only when she is so worn out from her
exhausting practice that she agrees to marry him. In part,
his support will help her to continue to practice.

Nan Prince is adroit and skillful at her work. When she

41
relocates the farmer's shoulder the last thing she feels is
apologetic. That George Gerry should be discomfited by her
treatment of her patient never enters her mind. She does not
tell anyone about her act mainly because she is modest, not
because she is embarrassed.

And Dr. Prance is frankly and forthrightly proud of her
medical work. She puts it ahead of her patients, in that it
is medicine, not their personalities or relationships, that
interests her the most. Social intercourse, for Dr. Prance,
is valid only if it has a medical context. By maintaining her
distance from others, both physically and emotionally, Dr.
Prance feels no pressure to become the kind of woman she is
not.

These women characters manifest a sense of
professionalism at a time when the medical community in the
United States was defining itself as a clear profession. Even
though women were excluded from the AMA and didn't necessarily
gain acceptance in other formal medical societies, their sense
of profession was no less strong. By achieving a high level
of medical competence, these women separated themselves from
average citizens as well as average doctors. Nan Prince was
esteemed amongst the medical establishment, and was recruited
to practice and study abroad. Dr. Zay was mentored by one of
the most prominent physicians in Maine. And Dr. Prance
competes for recognition with the top male physicians in the
country and abroad. Even if excluded from formal medical

establishments, these women had formed their own elite, though

42
private, associations.

These women characters also called upon altruistic
motives to qualify for entrance into the profession. They,
perhaps more than their male colleagues, are willing to
practice amongst women and the poor, and to address social as
well as physical problems. We have seen Dr. Zay's philosophy
in action, as she addresses social and public health issues.
And Nan Prince desires to educate her patients to prevent
disease, to a degree that Dr. Leslie does not reach. And
their altruism reaches to the kinds of practices and locales
that they choose. These women are challenged to treat
difficult cases that their colleagues can't handle, like Dr.
Susan and Dr. Zay, or to work with only women patients, like
Dr. Prance, in order that these women not avoid treatment or
get lesser care because of modesty or distrust. And Dr. Zay
and Dr. Prince choose rural Maine for their practices, more
because of medical needs there, rather than because they will
become rich or famous.

These women achieve a kind of social status, because of
their financial independence, because of their innate culture,
as with Dr. Zay and Dr. Prince, and because of exceptional
medical skill. This social status sets them apart from the
other women around them. Dr. Susan is clearly unlike the
whining men and women patients of the water cure
establishment. Drs. Zay and Prince achieve status in their
communities because of their modesty, femininity and skill,

and Dr. Prance because of her scientific and medical prowess.

43
The professionalism of these women physicians supports
them and gives them a mission to which they can devote their
lives. They develop identities based on their profession
rather than on their gender. The ideals of professionalism,
rather than of society, gave these women physicians direction

and strength.

CONCLUS ION

The nineteenth century American novels and short stories
about women physicians depict a broad range of women
physicians, from the stereotypically masculine to the
eminently feminine; from the intellectual to the political
radical, to the ideal mother. All of these women are in
search of the proper place for themselves in a changing
society. Some of them find that their place includes the
practice of medicine.

These works suggest that social pressure may cause women
physicians to lose faith in their original desires to practice
medicine. They also suggest that a woman's professional
identity may help her to overcome these social pressures and
define herself in different terms than what society normally
accepts for women. Only two physicians, Dr. Zay and Nan
Prince, seem able to satisfy both societal norms and
professional goals. Their practices flourish not only because
of their professional competence, but also because of their
ability to be like the feminine, modest, pure woman idealized
in the nineteenth century.

These fictional works.are important to read today because
they address concerns that are still current for ‘women
physicians. While the pressures for current physicians may be
a bit different, and while society's acceptance of women
physicians is at an all time high, much.of a woman physician's

support still comes from her professional identity. And, like

44

45

the nineteenth century women in these stories, the background
of a changing medical world makes the parallels even stronger.
While the nineteenth century fictional women physicians placed
great faith in the developing scientific knowledge base,
current women physicians depend as well on their expanding
psychological and social knowledge base. They must master the
latest. medical advances as ‘well. as possess psychosocial
competence in order to find credibility within the medical
profession.

Finally, these works challenge women physicians to make
hard decisions in their lives. Perhaps women should not be
afraid to endorse work as the center of their lives. If
medical work entails the same kind.of close relationships with
patients and community that women enjoy within their family
life, then current practice perhaps could take on the kind of
interpersonal intimacy that the nineteenth century fictional
women physicians enjoyed. Twentieth century women physicians
are also challenged to rethink where the responsibility for
family lies. Dr. Zay feels that she must find a "new man" if
she is to marry. She is uncompromising in what this man must
be like and the responsibilities he must take on at home in
order to support her emotionally. The failure of women to
uniformly take on this stance despite ever increasing
opportunities and competence within the work place, suggests
either that the power of men to prevent women's independence
(and men's dependence) is truly great, and/or that our

socialization to be "ideal women" is still very strong.

46

While the stories show that opposition to women
physicians existed, it was not this opposition per se that
deterred some of the women physician characters from
practicing medicine. Instead, for the fictional women, it is
the desire to conform with society's norms of proper behavior
and occupation for women that most prevent women's success in
the workplace. Today, with increasing demand for women
physicians, and with documented expertise of women physicians
in the psychosocial aspects of medical care, we see that some
conformity with social norms helps women obtain professional
validity and develop standards of patient care. While Nan
Prince and Atalanta Zay may have lived difficult lives within
their fictional worlds, they still provide valid models for
women physicians today.

Future research and study about the portrayal of women
physicians in literature would be helpful to better understand
why we have so few modern literary role models for twentieth
century women physicians. And, as diversity in race, sexual
orientation, and background of women physicians increases, it
would.be interesting and helpful for the:general understanding
of the role of wOmen in the medical profession, to investigate
the history and development of these women's medical careers
as well. Looking at a wide variety of ways of balancing life
and work is essential in order for us to evaluate and revise

the choices all of us have made in our lives.

LIST OF REFERENCES

LIST OF REFERENCES

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47

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Phillips, "A Doctor Spoiled," p 603.

48

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pfi_hmepieem_negieime. Philadelphia, PA: University of
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Readings in the History of Medicine and Public Health ed.
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For an example of hOW'the therapeutics of male and female
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Frederick C. Waite, "American Sectarian Medical Colleges
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Ludlow, "The Battle and Triumph of Doctor Susan," p 467.
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Ludlow, "The Battle and Triumph of Doctor Susan," p 478.

49

41.

42.

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44.

45.

46.

47.

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53.

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55.

56.

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Ludlow, "The Battle and Triumph of Doctor Susan," p 477.
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Elizabeth Stuart Phelps, Doctor Zay. New York, NY: The
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For an example of a male physician in Plattsburg, New
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essentially was worked to death after years of demanding
practice, see David S. Kellogg, M.D., A Docto at

hours: The Ppivate Journal of a Small-Town Doctor's
V 'e ' 8 - 9 . Brattleboro, VT: The Stephen

Green Press, 1970.

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Phelps, Qoepo; Zey, p 113.

Phelps, DQQLQI_ZQ¥: P 223-

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Jewett, A Country Doctor, 139.

P

P
Jewett, A_§pphp;y_ppepp;, p 84.
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P

Jewett, A Qountry Doetop,
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James, The Bostonians, p 45.

50

"Tilii'fliiiifliiiiiii