Fluidity of standards in medical education and practice in the antebellum United States

Throughout much of the nineteenth century, the practice of medicine did not require a medical degree of any sort, or even a high school diploma for that matter.Footnote ¹³ Medical schools typically conferred medical degrees on the basis of some amount of instruction and some period of apprenticeship, but such degrees were by far the least traveled path to medical practice; moreover, most students never even completed a medical degree.Footnote ¹⁴ Three-year apprenticeships remained, on average, the dominant path to the profession well into the late nineteenth century.Footnote ¹⁵ With westward expansion and the growing need for physicians, proprietary medical schools quickly mushroomed; often, and especially in cities, physicians opened schools with an eye first and foremost on profits. The competition for students from these emerging proprietary schools exerted downward pressure on the standards of training at the already existing medical colleges.Footnote ¹⁶

This fluidity in medical education during the antebellum period reflected, as well as reinforced, the poor organization of the medical profession in general.Footnote ¹⁷ The quality of medical care was low, and conventional “heroic therapy” often amounted to nothing less than patient torture.Footnote ¹⁸ In the early 1830s, social mistrust in conventional medical practices gained momentum, buttressed by outspoken critics of the plummeting standards in medical education. One such critic, Samuel Thomson, and his teachings on natural treatments quickly gained notoriety and a following.Footnote ¹⁹ “The Thomsonians, as his disciples were dubbed, embraced natural, unorthodox healing methods. As an alternative to traditional medical practices, the Thomsonians established their own medical schools and societies, challenged existing medical licensing legislation, and advanced novel methods of treatment.Footnote ²⁰ As a result of their organized political pressure, most states abolished restrictive medical licensing legislation in the 1830s and 1840s.Footnote ²¹

These developments contributed to a further deterioration in the standards of medical education and the reputation of medical practice. By the middle of the nineteenth century, anyone could begin to practice medicine, even with less than a year of study and no clinical experience.Footnote ²² Clinical facilities remained rare, while alternative medical schools, also known as sectarian or “irregular,” multiplied.Footnote ²³ Deteriorating medical standards went hand in hand with large groups of underprepared students. In academic year 1850-51, for instance, the pool of incoming medical students at Yale holding a bachelor’s degree prior to enrollment was a mere 26 percent, compared with 80 percent of incoming theology students and 65 percent of law students.Footnote ²⁴ In 1847, traditional physicians established the American Medical Association to address the urgent need to raise standards and “establish the hegemony of regular medicine over these disparate schools.”Footnote ²⁵ The desire for reform in medical training and practice opened a critical window of opportunity for access to medical education and the medical profession for diverse groups of people and medical philosophies.

Rising prospects for women’s access to medical training

The flux in medical standards and practices provided women with a unique chance to enter the profession. At first, their entry materialized mostly via unorthodox training routes. Indeed, for women, gaining access to “orthodox” medical programs reserved solely for their male counterparts was nearly impossible.Footnote ²⁶ As historian Neville Bonner commented, “In all the world in 1850, no regularly established medical school anywhere consistently opened its doors to women.”Footnote ²⁷ The Geneva Medical College went so far as to proclaim that Elizabeth Blackwell’s admission in 1847 was a mistake.Footnote ²⁸ The widespread opposition to women’s inclusion in medical institutions found many justifications. Victorian gender values prescribed a female code of conduct that was antithetical to the idea of women sitting in medical lectures and working in hospitals alongside men.Footnote ²⁹ Widespread societal opinion saw women as delicate and virtuous and held that they belonged at home. In this light, education about the cruelty of medical procedures and the mysteries of the human body would destroy women’s virtue. Also, most people believed that women were not suited to be physicians because they were considered to lack the stamina and strength of mind required for the rigors of medical practice.Footnote ³⁰ Economic motives also played a role. Male physicians opposed women out of a fear of competition, especially in terms of medical care for female patients. Other barriers to women entering the medical profession were groups and entities beyond the field of education—including hospitals reluctant to provide women with requisite internships, experienced physicians reluctant to offer them consultations, and landlords reluctant to let women even rent rooms for medical practice.Footnote ³¹

Alternative pathways, however, allowed women to join unorthodox institutions to such an extent that by the end of the 1850s, close to three hundred women managed to study medicine in one way or another.Footnote ³² Women’s medical colleges, four of which were founded between 1848 and 1870, were one such critical pathway.Footnote ³³ Women’s medical colleges emerged in response to the medical profession’s resistance, but also as a result of a rising social need for and insistence on educational and professional opportunities for women. Growing industrialization and urbanization increased opportunities for women’s participation in philanthropic and political activities in mid-nineteenth-century America, from the temperance and antislavery movements to the women’s rights movement. Women’s rights leaders demanded greater access to medical education and practice for women, especially in midwifery and obstetrics. Sarah Josepha Hale, an influential activist and editor of the popular Godey’s Lady’s Book, insisted on the need for women doctors and called male obstetricians an “outrage on female delicacy.”Footnote ³⁴ Through the work of the American Women’s Education Association, founded in 1852, Catherine Beecher and others advocated for women’s medical training, with a particular focus on taking care of children and the sick.Footnote ³⁵ Moreover, ladies’ physiological societies, founded in the 1830s and 1840s across the Northeast and West, disseminated knowledge on women’s health. Ladies’ academies introduced the subject of physiology and the practice of calisthenics as part of a growing health reform movement across the country stressing the importance of female personal health and hygiene.Footnote ³⁶ According to Morantz-Sanchez, “The health-reform movement provided a different alternative to a dissatisfied public, and it grew and flourished in the atmosphere created by vociferous debate between sectarians and regulars over more humane methods of treatment.”Footnote ³⁷ Through the ladies’ physiological societies, women—predominantly of middle-class status—started lecturing throughout the country; emerging women doctors often lectured publicly to advertise and support themselves.Footnote ³⁸ Medical reformers across the country supported the opening of segregated female medical schools.

While women’s medical colleges opened the medical profession to women, they faced enormous scrutiny.Footnote ³⁹ Owing to the colleges’ limited resources, their strong focus on women-related subjects, and the widespread opposition to women doctors, a mark of inferiority often attached to the schools.Footnote ⁴⁰ Even in the minds of many first-generation women physicians, the segregated schools could in no way represent “an adequate substitute for attendance at the best medical schools of America and Europe”; Zakrzewska, the Blackwell sisters, and other early women physicians (i.e., Mary Putnam Jacoby), all attended a coeducational college at some point in their medical training.Footnote ⁴¹

Medical training at what were widely referred to as “alternative schools” was yet another educational path for women.Footnote ⁴² In fact, coeducation was introduced early on at these alternative schools, starting in 1849 with the Central Medical College of Syracuse in New York. These alternative schools, however, were largely alone in opening their admissions, for it was not until the end of the century that “orthodox” medical colleges and universities would adopt coeducation, and only very slowly at that. The University of Michigan became coeducational in 1870; Howard University graduated 48 women in the period 1869-1900.Footnote ⁴³

Urban Cleveland and a progressive women’s network

In the 1850s, Cleveland offered a unique context for women’s professional participation, enhanced by a strong community network of advocates for women’s education that extended moral support, financial backing, and room and board to the female students. Cleveland’s rapid industrial development and growth opened opportunities for women to work and study. Incorporated as a city in 1836, Cleveland quickly benefited from the development of the Ohio water canal system. Docks and warehouses dotted the riverfront, and locally owned small businesses supplied the rising needs of the city and region.Footnote ⁴⁴ The discovery of rich iron and copper deposits in the 1840s brought significant investments in heavy industry. The completion of the Cleveland, Columbus, and Cincinnati rail line in 1852 placed Cleveland at the forefront of an extensive transportation network. By the end of the Civil War, sixteen iron factories were active on the riverfront, fifty Cleveland-based companies mined ore in Michigan, and Cleveland’s oil refineries processed one-third of Pennsylvania’s crude oil.Footnote ⁴⁵ Between 1840 and 1850 alone, Cleveland’s population almost tripled, from six thousand to seventeen thousand. In the expanding commercial economy, women were able to sell household goods and work as laundresses, house cleaners, dressmakers, milliners, washwomen, seamstresses, living domestic servants, and store clerks.Footnote ⁴⁶

Teaching, however, was one of the new professional fields that became especially attractive to Cleveland women. Between 1820 and 1860, school reformers across the Old Northwest promoted an expansive network of common schools, particularly in the large cities, that employed thousands of teachers.Footnote ⁴⁷ To satisfy the growing need for teachers, townships increasingly turned to women, who not only worked for less, but also improved the quality of classroom instruction.Footnote ⁴⁸ As Sklar reported, “In 1840 Ohio had 4,569 men and 2,946 women teachers. Ten years later the state had 9,130 men and 7,742 women teachers.”Footnote ⁴⁹ In 1845, Cleveland’s Board of Education oversaw thirty-four schools with 3,161 pupils; eleven male and thirty-six female teachers served those schools; by 1857, mostly all teachers were female (although no woman held a school principalship or served on a school board).Footnote ⁵⁰ There were also a handful of private Protestant and Catholic parochial schools that included girls.Footnote ⁵¹

The phenomenal expansion of schooling across the Midwest was matched by an impressive growth of mostly private institutions for the training of female teachers. Between 1828 and 1852, around 30 female seminaries and academies opened in Ohio, while of the 116 created for boys, at least 13 were also coeducational.Footnote ⁵² Although different institutions served different socioeconomic communities, in general, in the antebellum period, female seminary students came predominantly from the middle and upper classes. In Ohio, as Margaret Nash noted, three female colleges served Oxford, Ohio: Oxford Female Institute, Oxford Female College, and Western Female Seminary. While wealthy students attended the first two, where they learned music and embroidery alongside Latin, other, less privileged students attended the Western Female Seminary, where they divided their time between study and household work.Footnote ⁵³ Educational attainment levels at these institutions varied tremendously, ranging from the elementary to the collegiate. Oberlin College, which opened in 1833 and began admitting women in 1837, was located thirty miles southwest of Cleveland.

By 1852, the year Nancy Clark received her medical diploma from the Cleveland Medical College, the shift in public sentiment across the country had led to the creation of new medical institutions for women.Footnote ⁵⁴ Women in Cleveland demanded medical training opportunities. Such demands were part of a growing activism focused on women’s rights. Cleveland women participated in the two women’s rights conferences that took place in Ohio during this period: the 1850 conference in Salem that attracted two hundred women from Ohio, and the 1852 convention of the Ohio Women’s Rights Association in Massilon. During the latter, two Cleveland women, Caroline Severance and Martha Tilden, were elected officers. In 1853, Cleveland women hosted the prominent rights advocates and Oberlin graduates Lucy Stone and Antoinette Brown as speakers on women’s rights.Footnote ⁵⁵

Women’s rights activism spilled over into support for women’s medical training. In 1852, Cleveland activists formed the Female Medical Education Society—the first organization in the state of Ohio established “for the encouragement of Medical Education among women.”Footnote ⁵⁶ Although the Society resembled early nineteenth-century women’s benevolent societies, it set itself apart from them by pursuing a specific mission: assisting middle-class women to break into a previously inaccessible public sphere.Footnote ⁵⁷ The Society, formed “for raising funds, and for maturing a plan for educating indigent women in the medical profession,” provided one of the first medical student aid funds in the country established by women for women.Footnote ⁵⁸ In its constitution, the funding requirements included:

Over three years following the Society’s founding, members founded eight chapters throughout Ohio.Footnote ⁶⁰ Harriot Hunt, one of the first practicing women physicians in the country and a well-known women’s rights activist, joined with Caroline Severance’s family and others to lobby nationally for the Society and to publicize its efforts. In her travels across Ohio to places such as Elyria, Tiffin, Columbus, Cincinnati, and Yellow Springs, Hunt lectured on the urgent need for women to study medicine and on the hard work behind the establishment of branches of the Female Medical Education Society.Footnote ⁶¹ She even traveled to Cleveland to personally witness the coeducational opportunity at the Cleveland Medical College. “The medical college there,” she commented, “receives women as students, and they are in every respect on an equality with their brethren.”Footnote ⁶² In addition to providing funding through loans, Society members also offered encouragement to female doctoral trainees. Newspaper endorsements garnered support for women’s medical training throughout the state. To give one example from the city of Columbus, the Ladies’ Department of the Columbus-based Ohio Cultivator—a semi-monthly journal dedicated to agriculture, horticulture, and domestic industry—urged that the state

Internal dynamics and Nancy Clark’s admission to the Cleveland Medical College

In light of the continued widespread resistance to women in the medical profession, the coeducational period at the all-male orthodox Cleveland Medical College between 1850 and 1856 was more than unusual. Established in 1843, the Cleveland Medical College emerged as the Medical Department of Western Reserve College. Founded in 1826, Western Reserve College was at the forefront of the wave of denominational colleges that mushroomed across Ohio and the Midwest in the first half of nineteenth-century America (Figure 1).Footnote ⁶⁴ Located in the township of Hudson in Northeast Ohio, Western Reserve College’s mission was to train ministers and administrators in the classical tradition for the Western Reserve Territory.Footnote ⁶⁵ As with most all colleges of the time, Western Reserve had a fully “masculine character,” conceived “entirely based on what knowledge was most important for educating male leaders and professionals.”Footnote ⁶⁶

Figure 1.

Left, Hudson’s Western Reserve College, around 1860; right, cover of the Western Reserve College Medical School catalog for year 1868-69, featuring a drawing of the Medical School building, built in 1846, three years after the opening of the department.Footnote ⁷¹

Western Reserve College expanded its offerings in areas central to men’s training such as theology and medicine. In 1843, four physicians at nearby Willoughby University resigned from its medical department and left for the city of Cleveland, where they hoped to find better resources, more students, and higher compensation.Footnote ⁶⁷ These four professors of medicine, John Delamater, Jared Potter Kirtland, Horace Ackley, and John Lang Cassels, would become the founders of the Cleveland Medical College.Footnote ⁶⁸ They approached Western Reserve College with a proposal to open the first medical department in the city.Footnote ⁶⁹ On August 4, 1843, the Western Reserve College trustees voted to assemble “a Committee of Examination to present to this Board the names of suitable candidates for the degree of M.D.”Footnote ⁷⁰ The demand was large: sixty-seven students—all men—joined the first session, spanning sixteen weeks, on November 1, 1843.

The official inclusion of a medical department in the charter of Western Reserve College transpired later, in February of 1844, when the Ohio legislature authorized the college trustees “to establish the Medical Department […] in the city of Cleveland, in the same manner and with like power to confer degrees and award diplomas, as though the same Department had been established under said act hereby amended, at Hudson.”Footnote ⁷² Eighteen men received the degree of doctor in medicine that year. As Rose reported: “Under Dr. Delamater’s leadership, an enviable reputation was soon established; and as other institutions fell by the wayside, Reserve gained strength and became the oldest medical school operating continuously west of the Allegheny Mountains.”Footnote ⁷³

The Cleveland Medical College took off so quickly that within ten years after its establishment, in 1854, Dean Delamater was moved to boast of its successful growth. A series of local newspapers advertisements right before the November 5th start of that year’s sixteen-week-long course touted that it had seven faculty members, the latest medical equipment, and plans to erect a new medical building on campus to accommodate the rapid growth of the student body at the College.Footnote ⁷⁴ During the first half century of their affiliation, Western Reserve College and its medical department, the Cleveland Medical College, maintained an unstructured and oftentimes antagonistic relationship. While Western Reserve College lent its name to the Cleveland Medical College, the latter remained fully in charge of its financing and programming. All of its funding “came from tuition and what the medical faculty could beg or borrow.”Footnote ⁷⁵ Western Reserve College trustees met with the medical faculty on an annual basis to perfunctorily approve graduates, and the president of Western Reserve College signed diplomas, retaining $5 of the $25 graduation fee. The medical faculty boycotted the charge all the way up until the 1890s, when then president Charles Thwing started asserting stronger control over the department. Still, the medical department gained much credibility through its association with the liberal arts college.

The admission of Nancy Clark into the all-male Cleveland Medical College in 1850, seven years after the establishment of the College, took place quietly. Although she joined classes in November of 1850 alongside her male peers, Clark’s enrollment did not make news. Cleveland’s Plain Dealer duly reported on the upcoming start of lectures in the regular course on November 1, excitedly noting: “The class this year will be larger than ever.”Footnote ⁷⁶ Neither did news of her presence reach the public the following year. On September 2, 1851, the city newspapers announced the November 5th start of the sixteen-week-long course at the College, providing all details on the tuition and fees ($50 for tuition, $3 for matriculation, and $20 for graduation), and the room and board options (between $1.50 and $2 a week).Footnote ⁷⁷ No mention was made of a female student among all other new students.

It was not until her studies were complete that the public learned about Nancy Clark. In its coverage of the 1852 commencement ceremony of the Cleveland Medical College from March 3, the Plain Dealer listed Mrs. N. E. Clark of Sharon, Massachusetts, among the names of the fifty-four graduates who received their Doctor of Medicine diplomas. “Among the graduates,” the news reporter noted,

The reporter, who was clearly a supporter of women’s medical education, endorsed Clark’s accomplishment and expressed excitement about the community’s growing affirmation of female medical professionals. Surprisingly, however, the reporter did not highlight the fact that Clark was the first woman graduate of the Cleveland Medical College.

University records show that faculty discussions on whether to admit women to the Cleveland Medical College took place in the spring of 1850. Faculty minutes allude to faculty disagreements and hesitation regarding the admission of women. In one faculty meeting, Jared Kirtland, professor of physical diagnosis and theory and practice of medicine, proposed that “respectable ladies who were fitting for the practice of medicine be admitted to attend all the lectures of the School on the same footing as gentlemen.”Footnote ⁷⁹ When the motion was subjected to a vote, however, Horace Ackley, professor of surgery, proposed that a separate motion be added to also allow “respectable Negroes be admitted to the same privileges,” which effectively silenced the first motion.Footnote ⁸⁰ As a result, no final discussion of either motions took place and both were tabled.

Historical accounts of the medical faculty offer some further insights into these debates. Two of the most prominent faculty, John Delamater and Jared Potter Kirtland, were well-known supporters of admitting women to the Cleveland Medical College.Footnote ⁸¹ Both men were highly respected, experienced, and established physicians, and both had significant pull with the faculty in the Medical College. Delamater had taught at eight medical colleges before moving to Cleveland in 1842, and was recognized as “the best medical teacher in the United States … and among the finest physicians.”Footnote ⁸² Cramer reports that Delamater “aided the medical education of more young men than any other doctor of this time and was the most versatile of all contemporary medical school professors; he taught medicine, surgery, obstetrics, materia medica, pharmacy, pathology, anatomy, physical diagnosis, diseases of children, diseases of the skin, and diseases of women.”Footnote ⁸³ Delamater and his wife also supported advancing educational opportunities for women in the city. It was “by arrangement with the young Dr. Delamater,” reported the prominent educator Linda Thayer Guilford, that in 1849 the new building for the one-year-old Cleveland Female Seminary “was erected in a spot shady and sequestered beyond what one can now conceive”; John Delamater himself also taught physiology at that female seminary.Footnote ⁸⁴

The second physician, Jared Kirtland, was a graduate of the first group of students of the 1812 Yale Medical School, possessed versatile medical and scientific expertise, served in the Ohio legislature, and founded the Cleveland Academy of Natural Science (now the Cleveland Museum of Natural History).Footnote ⁸⁵ He was also an active member of the Ohio movement to reform medical education and raise medical standards of practice. Joining a committee on the deficiencies of medical education in the Second Ohio Medical Convention in 1838, Kirtland remained a regular contributor to the annual conventions.

Fewer insights on the position of the remaining five members of the faculty are available. Records on the surgeon Horace Ackley, one of the original four founders of the College and the proponent of the second motion, are sparse.Footnote ⁸⁶ Publicly regarded as “the most active and operative surgeon of Northern Ohio,” “a bold and skillful operator,” “gifted with a most remarkable self-possession in the presence of danger,” and “a splendid medical witness,” especially in cases of malpractice, Ackley was also known as a “gruff and intimidating man,” whose habits of intemperance were suffused with “profanity in the classroom and threatened violence to his critics.”Footnote ⁸⁷

The fourth member of the original group of founders, the Scotsman John Lang Cassels, professor of materia medica, pharmacy, and botany, built early relationships with both Delamater and Ackley when he joined Fairfield College as a student, and later through Willoughby and Cleveland.Footnote ⁸⁸ The fifth was Samuel St. John, professor of chemistry and medical jurisprudence. He was a graduate of Yale College, had trained in Europe, and had been a professor of chemistry, geology, and minerology at Western Reserve College since 1838. St. John was known as “a man whom no breath of suspicion ever touched, and whose integrity was a natural and essential part of his organization.”Footnote ⁸⁹ The faculty team also included Jacob J. Delamater, the elder son of John Delamater, educated at New York University.Footnote ⁹⁰

Despite limited historical records on the medical faculty’s position on women’s medical education, one can nonetheless draw some insights from what we know about their education and conduct. All faculty had been classically educated and were nationally recognized for their medical expertise, scholarly contributions, and work in founding academic societies. Waite commented that the faculty consisted of “scholarly men said to constitute one of the best balanced medical faculties in the country.”Footnote ⁹¹ Most of them were active participants in the medical associations and contributors to efforts to raise medical standards, while both Kirtland and Ackley served as presidents of the Ohio State Medical Society (1848 and 1852, respectively). Their training, achievements, and advocacy for rigorous medical standards might lead to the speculation that most of these men might have shared the prevailing attitudes of regular physicians to women’s access to the profession. In this context, Delamater’s and Kirtland’s record of support for women stands out as the outlier rather than the norm.

In addition, as Tuchman has argued, regular physicians at that time mostly linked women’s entry into the medical profession with alternative medical movements such as Thomsonianism or homeopathy and their educational institutions, which were more open to female students.Footnote ⁹² Upon its establishment in 1847, the American Medical Association itself adopted a code of ethics that forbade allopathic physicians from consulting with non-allopathic practitioners.Footnote ⁹³ As alternative medical schools admitted women in greater numbers, regular physicians and colleges sought to avoid “the taint of unorthodoxy” at all cost, including by admitting women to their ranks.Footnote ⁹⁴ Indeed, Jared Kirtland’s “ambivalence” and shifting attitudes toward the admission of women to the College coincided with the opening of the Western College of Homeopathic Medicine in Cleveland in 1850. Although Kirtland initially supported Nancy Clark’s entry in 1850, the following year he reversed his decision by instead proposing a resolution that “it might be inadvisable to admit any more women,” a motion that passed unanimously” and allowed the faculty to distance itself from the homeopathic institutions.Footnote ⁹⁵ Kirtland’s vacillation on the issue, however, emerged again in 1853 when he submitted a resolution authorizing the dean with “ultimate authority to admit women on a case-by-case basis.Footnote ⁹⁶

In the 1850s, there was a widespread belief that the presence of female students could indicate lower quality of education, which in turn could drive away male students. Such perceptions would have also affected Cleveland Medical College, and student enrollment numbers at that time, arguably, offer some corroborating evidence. Between 1850 and 1856, when women attended Cleveland Medical College, overall student enrollment fell by 57 percent, from 255 students in academic year 1849-50 to 110 students in 1855-1856, paralleled also by a decrease in graduating students.Footnote ⁹⁷ This dramatic drop in enrollment and graduation numbers during this period, however, may be attributable to other developments. Growing competition among medical schools in the area after 1850 undoubtedly could have influenced the College’s decision to admit women as a way of increasing student enrollments.

Despite there being no official decision by the faculty on whether the College should accept women’s applications, Nancy Clark nevertheless enrolled as a student in November of 1850. What is more, a second woman, Eliza Brown, also registered that fall. Listed as one of the non-graduates of the class of 1852, Brown must have taken classes sporadically over those two years.Footnote ⁹⁸ Dean Delamater, who served as their preceptor, apparently made a single-handed decision to admit them.

In Clark’s case, the high standing of Dean Delamater as “the elder medical statesman whose illustrious name and wise medical counsel were valued by both the medical and lay community,” along with the support of Jared Kirtland, may have been all that was required for her admission.Footnote ⁹⁹ Personal factors may have also played a role, as Nancy Clark’s family, the Talbots (Clark was her married name), and the wife of John Delamater came from the same area near Sharon, Massachusetts.Footnote ¹⁰⁰ Mrs. Delamater thus could have influenced Clark’s choice to attend the College as well as John Delamater’s support for her. The Talbot family’s high social standing in the Boston area could have also further tipped the scale in favor of her admission.Footnote ¹⁰¹ Finally, Dean Delamater may have chosen, at least initially, to admit her as an alternative student. This speculation is warranted in light of one of the 1850 faculty member’s recollection years later. According to that man, Nancy Clark enrolled in the College not as a regular medical student but as a student to be trained to teach physiology and hygiene at schools.Footnote ¹⁰² Because medical schools offered instruction in these subjects, some women who needed that training enrolled as medical students simply out of necessity.

The internal dynamics around the admission of Nancy Clark highlight the novelty as well as the coincidental nature of her enrollment at the Cleveland Medical College. At a time when women’s enrollment in all-male regular medical schools was rejected by society and the medical profession, Nancy Clark’s unique status required public clarification. In its news report on the 1852 commencement, the Daily True Democrat provided a short clarification that Clark’s graduation was an exception. Although a woman had earned a medical degree that year, the medical faculty had “deemed it advisable to exclude ladies from their classes in future.”Footnote ¹⁰³ An exception or not, Nancy Clark’s graduation did not end coeducation at the Cleveland Medical College.

Coeducation at the Cleveland medical college, 1850-1856

News about the coeducational opportunities at the Cleveland Medical College spread, and women’s applications flowed in. Even before Nancy Clark’s graduation, a woman, Adna Sherman, registered in the fall of 1851 (listed as a non-graduate in the class of 1853).Footnote ¹⁰⁴ Three women then registered in 1853: Mary Frame Thomas, Eliza Lucinda Smith Thomas, and Emily Blackwell (listed in the class of 1854).Footnote ¹⁰⁵ All three attended the College for one year only, but only Emily Blackwell graduated in the spring of 1854. The other two attended medical lectures sporadically throughout the year.

Emily Blackwell had completed a year of study at the all-male regular Rush Medical College in Chicago, which then denied to readmit her for the second year of training under pressure from the local medical society.Footnote ¹⁰⁶ Similar to Nancy Clark’s admission three years earlier, personal connections influenced Blackwell’s admission to the College in 1853. Dean Delamater had once served as mentor of Emily Blackwell’s teacher and mentor at Rush College, Daniel Brainard, and could have been well disposed to her application based on that connection.Footnote ¹⁰⁷ In 1854, the Plain Dealer, matter-of-factly—as if women graduates were a common phenomenon in Cleveland—listed her as one of the forty-five graduating “gentlemen,” and acknowledged the presence of Nancy Clark in the audience: “A large number of ladies and gentlemen were present. Among the ladies was Mrs. Nancy E. Clark, M.D., who graduated from the Institution two years ago.”Footnote ¹⁰⁸

And when later, in 1856, four women appeared among the thirty-nine graduates, the Plain Dealer emphasized their achievements and listed them all as a ladies’ group, indicating that women’s enrollment at the Cleveland Medical College was now no longer a novelty:

Despite these developments, women doctors remained few and far between, a curiosity of sorts, especially if they graduated from a regular all-male medical college.Footnote ¹¹⁰ The hall where the commencement exercises took place that year was

Marie Zakrzewska’s admission to the College was greatly facilitated by Elizabeth Blackwell, who appealed to her sister’s contacts in Cleveland.Footnote ¹¹² Cordelia Greene, who had read medicine with her father and had worked a nursing job in his “water cure” facility in Castile, New York (a hydropathic sanatorium that used water for healing as an alternative to conventional medical treatments), transferred in the fall of 1855 after completing a year at the Female Medical College in Pennsylvania.Footnote ¹¹³ She was joined by another woman, Elizabeth Griselle. Six of the ten women who attended the College between 1850 and 1856 eventually earned a medical degree.

Entering medical school, and a traditionally all-male one at that, marked a turning point in the lives of these women. Their belief in service to others pushed them to defy the prevalent norms, but social disapproval always accompanied them. When Marie Zakrzewska enrolled in 1854, she received a disapproving letter from her own father. For him, the medical profession was intended for men and, were she a man, he would be immensely proud of her. “But you are a woman,” he wrote, “a weak woman; and all that I can do for you now is to grieve and weep. O my daughter! Return from this unhappy path.”Footnote ¹¹⁴ In fact, in her autobiography, Zakrzewska shared her belief that people were “afraid of female medical students”; and “to seek the acquaintance of a woman who wished to enter “legally” upon the same work which these doctresses performed was considered of very doubtful respectability.”Footnote ¹¹⁵ She consistently sensed this opposition in public:

In her diary, Emily Blackwell also wrote of her aspirations to devote her life to the benefit of others and never failed to mention her constant prayers to God to give her the ability to look back on a “woman’s work done for thee and my fellows.”Footnote ¹¹⁷ Societal approbation kept these women isolated. Most of them “withdrew entirely into their own abodes.”Footnote ¹¹⁸ As medical students and physicians, the women graduates of Cleveland Medical College were not only outliers among women for having studied medicine; they were outliers among female doctors in general for having achieved a degree from a regular all-male medical college while many of the first generation of women doctors received their degrees from sectarian institutions or female colleges.Footnote ¹¹⁹

According to Goldstein, during the time when all four women were together in Cleveland, they “provided each other with support and companionship.”Footnote ¹²⁰ Along with social stigma, an unwelcoming peer climate confronted these women at the Cleveland Medical College. As a result, they tended to stick together, spending both their study time and free time with one another. In the words of Zakrzewska, “we trotted unconcernedly by neighbors staring from behind half-shut blinds, twice a day, to and from our college. And there being four women among a couple of hundred young men, we had our box seat to ourselves, unmolested by the tobacco-chewing and spitting Æsculapians in embryo.”Footnote ¹²¹ Unlike other, more extreme examples of harassment and discrimination by their male peers at medical schools, the women students at the Cleveland Medical College reported “little to complain.” Although the men did not like the women’s presence and ran a petition to discontinue coeducation, and though some professors also opposed the policy, overall, the women were not openly molested.Footnote ¹²²

As much as Victorian society considered women different from, or indeed inferior to, men intellectually, physically, and psychologically, the women medical students in Cleveland completed the same medical curriculum and anatomy labs as their male counterparts, demonstrating their ability to be successful in a demanding medical training program in a regular all-male college.Footnote ¹²³ The College also allowed the graduating women to focus their final theses on medical topics that defied traditional expectations. For example, Nancy Clark completed her graduation thesis on the internal healing processes of the body and especially the relationship between the brain, heart, and lungs, while Emily Blackwell’s thesis investigated the overuse of medications.Footnote ¹²⁴

The quality of work the women accomplished received its due recognition. Zakrzewska provided an account of the “full marks and high honors” with which her female peers graduated. In her last winter term, she even pointed to the overall influence the women’s hard work exerted on the entire class, noting that “all studied more closely than they had ever done before—the men not wishing to be excelled by the women, nor the women by the men.”Footnote ¹²⁵ In fact, a professor shared with her that that year’s theses were all so unprecedently good that the faculty chose thirteen to be read at Commencement rather than the usual three. The high quality of the women’s work is corroborated by other sources as well. In his personal journal, Sam Blackwell, Emily Blackwell’s brother, shared a comment her sister received about her final exams: when she was leaving the exam room, she overheard one faculty member note to another: “This is the only student you have passed whom I would introduce to practice in my family.”Footnote ¹²⁶ The faculty awarded Emily a grade of 11, above what was ordinarily the highest possible final grade of 10.Footnote ¹²⁷

A Cleveland community network of support

The city of Cleveland and its community not only provided the context for sustained coeducational opportunities at the Medical College but also exerted a critical influence on the women students. Although sparse, records attest to the active support of diverse individuals. Marie Zakrzewska’s autobiography speaks about several of them. To start with, she initially received free room and board from Caroline Severance and her family.Footnote ¹²⁸ As social reformers who actively participated in the women’s rights and abolitionist movements, the Severances often hosted prominent antislavery and women’s rights advocates and intellectual speakers visiting Cleveland, spending “long evenings of intense conversation.”Footnote ¹²⁹ Caroline Severance attended and helped coordinate women’s rights conventions across Ohio, Indiana, and New York, wrote and lectured on women’s rights, ran the first annual meeting of the Ohio Women’s Rights Association in 1853, and founded her own American Woman Suffrage Association.Footnote ¹³⁰ She was also the president of Cleveland’s Physiological Society and her network of supporters of women’s medical education was open to Zakrzewska, introducing her to Harriot Hunt, Nancy Clark, and other active female physicians.Footnote ¹³¹ Severance’s activities gained her notoriety as Cleveland’s “preeminent women’s rights proponent.”Footnote ¹³²

The Severances, along with other Cleveland citizens, provided support for the women medical students all along. Both Marie Zakrzewska and Sarah Ann Chadwick received financial support from the Ohio Female Medical Education Society. Zakrzewska also boarded with a Mrs. Shepherd, Rev. Mayo, and the Vaughan family, and in each case, her room and board was covered by the Female Medical Education Society. Rev. Mayo was especially influential in her development. Hunt described him as the leader “over a new religious society;” for Hunt, “his religious nature is so deep, so finely developed, so active, and so healthful, that he can afford to be progressive.”Footnote ¹³³ An abolitionist and a social rights activist, Rev. Mayo opened “a new world” to Zakrzewska; he introduced her to new ideas and “circles of reformers” that included individuals such as Theodore Parker, William Lloyd Garrison, Wendell Phillips, and Sarah Grimké.Footnote ¹³⁴

Support for the female students also came from the medical faculty itself, especially Dr. Delamater. Zakrzewska mentioned his kindness, his eagerness to work with her as a preceptor, and his professionalism; she called both him and Kirtland “men of natural genius.”Footnote ¹³⁵ She also talked about the support of the faculty generally, many of whom waived her tuition costs, crediting her “on the lecture fees for an indefinite time.”Footnote ¹³⁶ And she spoke of friends in Cleveland such as Dr. Seelye, a practicing physician who ran a “water cure” establishment, and the Vaughan family, members of Rev. Mayo’s congregation, who offered her housing in her second winter academic term and through whom she met guests and prominent speakers such as, to quote from her own recollection,

Women students’ encounters with the progressive circles of Cleveland exposed them to the ideas of the social rights movements. Zakrzewska herself later acknowledged the transformative role that Cleveland and its community had had on her views. The support she received from women’s rights activists influenced her own attitudes, and years later she paid her educational debts forward, extending support to other women medical students. In her overall account, she remembered, “In spite of the pecuniary distress from which I constantly suffered, I was happier in Cleveland than ever before or since.”Footnote ¹³⁸

As a foreigner and someone older and more experienced, Zakrzewska, however, stands as an outlier in her attitudes and beliefs among the women graduates. The progressive network students encountered may have been one of the factors that influenced Zakrzewska’s belief that any doctor, man or woman, should receive holistic training. At a time when most women physicians emphasized feminine virtues as leverage for their entrance into the profession, Zakrzewska believed that the study and practice of science/medicine “has no sex”; any physician, male or female, had to be “thoroughly trained,” and had to possess “an earnest desire and love of scientific investigations.”Footnote ¹³⁹ Cleveland’s transformative environment could have determined her lifelong opposition to the gendering of science.Footnote ¹⁴⁰

The legacy of Cleveland medical college’s early coeducational opportunities

The women physicians who studied at Cleveland Medical College in the middle of the nineteenth century left indelible marks on the medical profession. Historians have more records on some of them than on others. After graduating from the Cleveland Medical College in 1854, Nancy Clark journeyed to Paris with her brother, also a physician, in an effort to gather clinical experiences.Footnote ¹⁴¹ Upon her return, she joined Harriot Hunt, hitherto the only woman practicing in Boston, with her own medical practice.Footnote ¹⁴² Similarly, Emily Blackwell, upon completing her studies, spent two years in France gaining clinical experience in the Maternité hospital in Paris and in the clinics of the leading physicians James Paget, James Simpson, and others.Footnote ¹⁴³ In 1857, together with her sister Elizabeth, she founded the New York Infirmary for Women and Children and later, in 1868, established the Infirmary’s own Woman’s Medical College.Footnote ¹⁴⁴ From its first day, this college complied with all suggested reforms of the American Medical Association.Footnote ¹⁴⁵ The Infirmary provided clinical training to women medical graduates from diverse institutions, many of whom later founded their own hospitals across the Midwest and West, all patterned after the Infirmary.Footnote ¹⁴⁶ A year after the Blackwell sisters established the Woman’s Medical College, Elizabeth left the US for England, leaving Emily to run the institution.Footnote ¹⁴⁷

After graduating from the Cleveland Medical College, Cordelia Greene spent six years in Clifton Springs, New York, assisting in the water-cure clinic of a fellow graduate from Cleveland. She then returned to her hometown of Castile to run as medical director of her father’s water-cure sanitorium. Throughout her life, she often lectured on preventative medicine and served on medical societies across the state of New York and the country.Footnote ¹⁴⁸ After earning her medical degree, Elizabeth Griselle practiced medicine in Cleveland for six years and then moved her practice to Salem, Ohio, where she remained for the rest of her life. She was part of the founding of the Union Medical Society, completed postgraduate study at the Women’s Medical College in Philadelphia while also working as assistant physician in the city’s Women’s Hospital, and worked as attending physician at the Hospital for Women and Children in San Francisco. Similar to the other women, she also lectured and published on medical issues.Footnote ¹⁴⁹

Historians know more about Marie Zakrzewska thanks to her numerous publications and autobiography. After graduation, she joined Emily and Elizabeth Blackwell at the New York Infirmary for Women and Children, spending three years there. She then taught as professor for another three years at the New England Female Medical College. In 1862, at the age of thirty-three, she founded the New England Hospital for Women and Children, which she ran for thirty-seven years and where she established herself as a leading medical practitioner and educator of women physicians.Footnote ¹⁵⁰ Her hospital was critical in offering rare internships to women. In fact, as Bonner reports, “only the women’s hospitals launched by Zakrzewska in Boston, by Preston in Philadelphia, by the Blackwells in New York, and by Thompson in Chicago were freely open to women interns and individual students.”Footnote ¹⁵¹ Her hospital emerged as “one of the most important women’s medical institutions in the nineteenth century.”Footnote ¹⁵²

Most of the women graduates of the Cleveland Medical College remained close for the rest of their lives. According to Goldstein, four of them did not marry, and each of them adopted at least one child throughout their lives. When medical associations finally started admitting women in the late 1870s-1880s, five of the six female graduates gained admission to the elite American Medical Association during their lifetime.Footnote ¹⁵³ All of them practiced medicine throughout their lives, and at least three of them played leadership roles in nurturing other female physicians.

After 1856, however, as Dean Delamater was slowing down with age, the Cleveland Medical College quietly and with the support of all faculty discontinued women’s admissions. The decision reflected the American Medical Association’s recommendation, adopted in 1856, to bar women from medical schools. Most of the existing colleges across the country followed that recommendation.Footnote ¹⁵⁴

For more than two decades after 1856, no woman enrolled at the Cleveland Medical College. In fact, other medical training facilities in Cleveland also barred women. In 1868, the Western Homeopathic College, founded in 1850 in Cleveland as the second such institution in the country, suspended the awarding of medical degrees to women.Footnote ¹⁵⁵ In 1879, the Cleveland Medical College voted to open its doors to women, but only three women completed their studies over the following five years, with Sarah Adelaide Tilden as the first to graduate, in 1880.Footnote ¹⁵⁶ In 1886, Western Reserve College officially discontinued coeducation and the Medical College did not allow women access to it again until 1918.

In the middle of the nineteenth century, a small group of women broke new ground by pursuing their medical degrees at the traditionally all-male, regular Cleveland Medical College despite the strong resistance of the medical profession and social norms. The College’s short but unparalleled foray into coeducational medical training marked a historic event, facilitated by a unique confluence of factors. A period of transition in the medical profession and fluidity of medical standards, rising educational and professional opportunities for women, the urban context of Cleveland and its supportive community of progressive activists, and individual faculty members at the Cleveland Medical College all coincided to open a new coeducational opportunity for women medical students. The female graduates of the Cleveland Medical College emerged as central figures of a generation of women physicians who contributed to the development of medicine and opened the doors of the profession to women.