Dr Edward Atwater, long a bulwark of the medical history community in the United States, has completed an almost lifelong labour of love AND produced one of the most readable, multifaceted and useful biographical reference tools to appear since Islamic scholars started the genre. The only thing shocking is that for the first time we have actual data on women physicians of the first generation. Most of the conclusions (found in the introduction) simply confirm the qualitative understandings provided by Regina Morantz-Sanchez (Sympathy and Science: Women Physicians in American Medicine, Oxford University Press, 1985) and other excellent scholars of the subject; but still data are nice to have.
Begun before the internet put the census and newspapers from many hamlets and towns on our desks, the debts to librarians and archivists are enormous and graciously acknowledged. Dr Atwater combed the catalogues of American medical schools, journals, regular and sectarian, and a host of directories and biographical sources. In the end he identified fourteen schools which graduated a total of 280 women between Elizabeth Blackwell’s well known graduation in 1848 and the Civil War. The beginning is obvious, the end based on the dramatic social dislocation and changes wrought by the war.
The author is the first to hope other data will appear as scholars build on his work, but I am sure any new finds will not change the broad outlines of his work. The area of greatest improvement will be additional detail; he has biographical information on only 222 of the 280. Some of the 222 biographies are sparse; others – like the opening bio of Dr Blackwell – robust, because of the previous work by two generations of scholarship on American women physicians. Dr Atwater used the criteria of graduation from a state chartered institution, although he provides a list of names for a handful of individuals who received training in institutions that had no charters. The standard means his physicians represent all sects of antebellum American medicine; of the fourteen schools, six were allopathic, six eclectic and one each homeopathic and hydropathic. That being acknowledged, the author’s greatest regret is the dearth of information on the actual clinical work these women did.
Using the census, an admittedly frustrating and variable source, and other data, Dr Atwater provides critical demographic data: birthplace (predominantly northeaster), age at graduation (an older 33ae) and marital status (almost a quarter never married and a third had physician husbands), as well as other variables. Perhaps the most important variable is motivation: why did they do this unusual thing of becoming a physician? Not surprisingly, the primary motivation was economic, a need to provide for self and dependents. But almost as common was prevention: many had lost a family member to illness and wished to know how to protect others. This preventive orientation, Dr Atwater believes, set these physicians apart, but the male data are still impressionistic.
Among the most important findings: while most were reform minded, involved in abolition, temperance, suffrage, etc., they did not enter medicine to open it to women. The most compelling finding is that ‘[m]ost went out into small communities and took care of patients’. No physician could give or desire a better epithet. I predict the author’s compelling introduction of this book will become required reading in a variety of medical history and women’s history surveys, and it should be in more.
The individual biographies are generally well crafted and thoroughly documented, although there is an alarming tendency, at least to this nearly superannuated reviewer, to see Wikipedia as a legitimate and enduring source, forgetting that it is malleable and needs to be cited with an accession date. My only editorial suggestion is more textual cross references: each physician is listed by the surname with which she graduated medical school, many were better known under other names. The cross references are in the index, but a few extra lines in the text for ‘see’ references would no doubt help some readers who will not intuitively go to the index in an alphabetically organised dictionary. Still, these are small issues beside this enormous contribution, which will both help and challenge future generations of students and scholars.