Women and the Practice of Medicine: A New History (1950-2020)

By Lucille A. Lester

This text offers a new interpretation of the dramatic changes that occurred in women in medicine over the course of the last seventy years, starting from the 1950s when women physicians were a curiosity to the present day when their presence is accepted and their achievements are broadly acknowledged. In seven chapters arranged by decades, this book examines the seminal events that shaped what has been described as “the changing face of medicine.” Using the lived experiences of women physicians featured as vignettes throughout the narrative, the book traces the effects of the quota system for admissions, second wave feminism and Title IX legislation, the restrictions of the “glass ceiling,” and a cascade of “equity issues” in career advancement and salary to offer a new account of the roles women played in shaping the standards and the contributing to progress in the field of medicine. Women faced gender specific challenges to enter, train and practice medicine that did not abate as they strove to balance work and family. As the book shows, such challenges and the attendant institutional responses offered by medical schools and government rulings shaped how women “do” medicine differently. Women and the Practice of Medicine offers a unique interpretation of this history and accounts for the changes in social norms as well as in women’s perspectives that have made them an invaluable “new normal” in the contemporary world of medicine.

This book fills a gap in the more recent history of women in medicine, much of which is written by academic historians or sociologists; this book contributes a clinician’s “on the ground” point of view. It includes a researched, structured historical narrative spanning the last 70 years, but it seeks to frame this narrative with the personal stories and accomplishments of women physicians who lived through the time in question. The book also provides an overview of how much has changed in the practice of medicine as well as a reminder of what has not changed and what needs to further evolve for women to be equitable partners in medicine as well as other professional disciplines.

The book concludes with two appendices containing a questionnaire used in interviews of 40 women conducted at the start of the book project, and a summary of the qualitative findings from the semi-structured interviews.

• Language: English
• Publisher: Springer
• Release date: Jun 30, 2021
• ISBN: 9783030741396

Book preview

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2021

L. A. LesterWomen and the Practice of Medicinehttps://doi.org/10.1007/978-3-030-74139-6_1

1. The 1950s: The Quota System

Lucille A. Lester¹  

(1)

The University of Chicago, Chicago, IL, USA

Defintion: Quota—"the number or percentage of persons of a specified kind permitted to enroll in a college, join a club, immigrate to a country, etc." (1660–1670, Medieval Latin: short for quota pars-how great a part). (The Random House Dictionary of the English Language, 2nd ed. New York: Random House; 1987)

Vignette: Dr. Janet Davison Rowley was the Blum-Riese Distinguished Service Professor of Medicine, Molecular Genetics and Cell Biology and Human Genetics at the University of Chicago who in the 1970s made a series of discoveries linking specific chromosomal changes to certain kinds of leukemia and lymphoma. Her work fundamentally changed the way cancer could be understood and eventually led to the development of drugs to treat cancer-specific genetic abnormalities. After obtaining a BS degree from the university in 1944, she was accepted into the University’s medical school, but, as she reported it, "the quota—three women out of a class of 65—was already filled, so I had to wait 9 months." She was only 19 at the time and she did matriculate with the next year’s class and obtained her MD in 1949. She married a fellow medical student soon thereafter and raised four sons while continuing to work in various capacities as a researcher in the United States and abroad. Her first academic position was as a clinical associate at the University of Chicago where in 1962 she was given laboratory space, a microscope and a salary of $5000. The discoveries she made and the work that she and her colleagues and numerous trainees did over the years led to over 500 publications and resulted in seminal changes in our understanding of cancer biology. She rose through the ranks in academia and received innumerable accolades and national and international awards, including the prestigious Medal of Freedom from President Barack Obama before her death at 88 in 2013. A quota system had delayed her entry into medical school (source: https://www.uchicagomedicine.org/forefront/news/cancer-genetics-pioneer-janet-rowley-1925-2013 )

Historical Background: The Origin of Quotas

I graduated from medical school in 1972 as 1 of 6 women in a class of 80. A graduate student friend from the small liberal arts university I attended in the Northeast told me that I must have been admitted a part of a quota system. I matriculated with generous scholarship aid and felt fortunate to be admitted; I performed on an equal footing with my peers and graduated with distinction. I never gave the idea of quotas much thought. During medical school and after as a trainee (intern, resident, and fellow) and later as a faculty member at that same institution, I frequently walked the corridors in one of the older buildings that displayed the yearly composite pictures of the medical school graduating classes beginning with pictures from the mid-1930s. What was striking to me was that each class included 2–6 women through to the mid-1970s, despite the fact that the total number of students per year increased from 40 to 89 during that period. Where were the rest of the women, I wondered, were no others qualified, or were some denied admission? Was there a quota system as was suggested to me at the time of my admission? This question led me to choose the title for this chapter. I was curious to know who these women were and why they, in particular, were admitted. I wondered also whether there were external pressures from legacy families or generous donors who had certain stipulations—including perhaps the admission of women—attached to their gifts. I also sought to document what happened to these women, what fields were open to them, and what kind of lifestyles they experienced. As I attempted to answer some of these questions, the issue that needed to be resolved was whether the small number of women in the classes of this school as well as others was attributable to a deliberate quota system, or solely related to societal factors at work during this time. I chose to examine further some of the available historical information in an attempt to answer this question.

The factors contributing to the quota system that existed in the time period addressed in this chapter (1950–1960) had clear antecedents in the early part of the previous century (1850–1860) and in the years that followed, when women were openly denied formal medical training at established institutions. Elizabeth Blackwell is generally recognized to be the first woman to receive an MD degree from an American medical school. She was admitted to the Geneva Medical College in western New York State in 1847. She was accepted there after applying to all of the established medical schools in New York and Philadelphia and 12 more schools in the Northeast. The circumstances related to her acceptance and admission are frequently cited and are interesting: the faculty, not wanting to be responsible for rejecting her outright, decided to put the subject of her admission to a vote by the all-male student body; the students returned a unanimous yes vote—allegedly as a joke.¹ Once she received her degree in 1849, the school closed its doors to women for many years; it was ultimately closed in 1871, and its faculty transferred to Syracuse University. In 1849 and in 1850 when Harriet Hunt applied to attend lectures at Harvard Medical School , after practicing medicine in Boston since her apprenticeship in 1835, she was denied permission to do so. In the first instance, the denial came from the president of the Harvard Corporation who reportedly stated that it was inadvisable to change the existing regulations of the medical school, which implied that the students were exclusively male. In the second instance, despite a letter of reference from Oliver Wendell Holmes , Dean of the Medical College, she was denied access to lectures. This occurred after a protest by the male-only medical students who stated that they must preserve the dignity of the school and their own self-respect.²

The forces that worked to keep women out of medical schools and the upper echelons of medical practice, in particular from the East Coast establishment of licensed practitioners, appear to be the product of two important prevailing attitudes, one sociocultural and the other professional. The cult of true womanhood which was accepted as the standard for female behavior in the mid-nineteenth century, held that four cardinal virtues of piety, purity, submissiveness and domesticity were of utmost importance and helped to define women’s very limited sphere of influence.³ No respectable women would consider a career in medicine, and as Hunt herself stated: women simply did not dare apply… Adding to this prevailing sentiment was the push for the professionalization of medicine at that time. The licensing of physicians to practice medicine, the establishment of medical societies, and the creation of degree granting established medical colleges all actively worked to close their doors to women.

Women had been practicing medicine and had established their own colleges and hospitals, but they were for the most part outside of the established sphere of medical practice that was the sole purview of men. Midwifery is a prime example of the effect of professionalization on women’s practice that began to exert its effects even a few decades before this period. Women had been midwives from colonial time in America and well before (and before written records exist), but as noted by Walsh, in 1820, Dr. Walter Channing , Professor of Obstetrics at Harvard Medical School, stated that women could not be considered competent to practice obstetrics without formal training in medicine.⁴ This was despite the fact that they had been delivering babies and providing care for women for centuries and despite the fact that he was a prime supporter of moves to keep such women from getting medical training! There are numerous other examples of well-qualified, highly motivated women who were denied any access to formal medical education, and these many stories are fascinating but beyond the scope of this work. They do however lead one to question whether active discrimination and the resultant denial of access to women were not antecedents to the quota system—a system that was the result of significant societal pressures and changes during the early years of the twentieth century. In the interim, American women who were persistent and unwavering in their quest did obtain formal medical education in two ways: by training in major European Universities—primarily in Paris, Zurich, Bern, Geneva, and later Vienna where they trained along with women from Britain, Germany, and other primarily western European countries—and by establishing their own medical colleges and eventually their own clinics and hospitals exclusively for training women.

Training Abroad: Women in Medical Schools with Men

Thomas Bonner in To the Ends of the Earth: Women’s Search for Education in Medicine chronicles the personal stories of a number of outstanding American women who after gaining admission to schools in Zurich and Paris excelled and earned prizes and distinction.⁵ In 1868, Mary Putnam , the daughter of a successful New York publisher, was the first woman to matriculate in the prestigious Ecole de Medecine in Paris. She had been living in Paris for 5 years and overcame many obstacles to even attend lectures. In 1871, she was awarded high praise and a bronze medal from the faculty for her defense of a thesis prepared for completion of her medical degree. The award was reportedly one of only three awarded to women in the first 20 years of women’s study of medicine in Paris. Also in 1871, 24-year-old Susan Dimmock from North Carolina defended her MD dissertation in Zurich on The Different Forms of Puerperal Fever, to high praise and an acknowledgment from at least one faculty member that it is possible for women to devote themselves to the medical profession without denying their female nature.⁶ Bonner points out that Paris and Zurich were in fact the only cities in the world at that time where women could learn scientific medicine on the same basis as men. Many male physicians from the United States also sought scientific-based medical training and spent time in Paris, Vienna, Zurich, and Germany.

Women’s Medical Colleges in the United States: A Brief History

Pololi in 2010 in her seminal work Changing the Culture of Academic Medicine includes a summary of the arguments US medical colleges offered for resisting the admission of women for decades: women should be in domestic roles, their intellect was inferior, menstruation was debilitating and prevented them from functioning, they had a tendency to hysteria, and so forth.⁷ Many in charge of the schools felt that women would be an undesirable distraction to the male students if they were allowed to attend classes together. Some also considered it highly improper to discuss medical topics in mixed company. Dr. George Shattuck of Boston argued against the admission of women to the Massachusetts Medical Society in 1882, and he reminded councilors of that organization: God’s plan for the universe had not included women doctors.⁸

Women seeking medical education and training faced a difficult road indeed, and one answer to this problem in the mid- to late nineteenth century was to establish their own medical schools. Between 1845 and 1895, 17 women’s medical colleges were established in the United States. By the early 1900s, 14 of the 17 had closed or merged with established coeducational schools. Five of the larger well-supported schools were in major US cities and are worthy of mention here:

TheBoston Female Medical College was founded in 1847 by Samuel Gregory in part as a result of his strong moral and religious opposition to men practicing Obstetrics and Gynecology or midwifery.⁹ In 1856, the name of this institution was changed to the New England Female Medical College by an act of the Commonwealth of Massachusetts. It was the oldest medical school for women in the United States; it merged with Boston University School of Medicine in 1874.

Woman’s Medical College of Pennsylvania(WMCP) was founded in 1850. Forty women were enrolled that year—8 to work for an MD degree and, by report, 32 to listen.¹⁰ WMCP had at one time enrolled as many as 10% of all female medical students in the country.¹¹ After a brief period of offering admission to men, WMCP remained open until 1993 at which time it merged with Hahnemann Medical School in Philadelphia. It was the last of the separate schools for women in existence in the United States. In 2003, the two schools were absorbed by the Drexel University College of Medicine .¹²

Woman’s Medical College of the New York Infirmary was opened in 1865 by Elizabeth and Emily Blackwell and Marie Zakrzewska . In 1857, they had established the New York Infirmary for Women and Children to serve the indigent immigrant population of lower Manhattan and eventually to provide practical medical training for women completing what then passed for medical schools in America. The school became one of the first to require a 4-year curriculum, and it remained open until 1899 when Cornell University began admitting women to its medical school. The infirmary remained open until 1996 when it merged with the New York University Medical Center; by then it had treated over one million patients, mostly immigrants. Zakrzewska later opened and for many years directed the New England Hospital for Women and Children in Boston, long a highly sought after place for women to obtain clinical training that was not available to them elsewhere. Virginia Drachman chronicled the long and often fraught history of that institution which finally closed its doors in 1969. Her excellent history of that institution addressed the complex argument of separate vs equal in the medical education of women—one that would take place for some of the same reasons at the Woman’s Hospital of Pennsylvania some years later.¹³

Dr. Mary Harris Thompson who had graduated from the Boston Female Medical College in 1863 founded the Woman’s Medical College of Chicagoin 1870. In 1865, she established a hospital for women and children in Chicago after not being able to find a position in any Chicago hospital. The hospital treated indigent women and children including wives and widows of Civil War Union soldiers, and it operated primarily on donated funds. The faculty of the school secured an alliance with Northwestern University Medical School in 1892, but in 1902, due to insufficient interest in funding women’s medical education, what was by then called the Northwestern Woman’s Medical School was closed.¹² The hospital, which was exclusively staffed by women until the mid-1970s, closed in 1988 for financial reasons. The building on the near west side of Chicago remains in use as the Women’s Treatment Center, an outpatient and residential substance abuse center for women and their children.

The Woman’s Medical College of Baltimore opened in 1882 but closed in 1910 after an unfavorable report from the Flexner committee that revealed limited enrollment, facilities, and funds.¹⁴ Also, in 1893, Johns Hopkins admitted the first women; some of the faculty of this institution apparently moved there as well.

During the late nineteenth century, separate women’s medical colleges played a key role in the education of women physicians. Sixty-three percent of women enrolled in established (non-sectarian) medical schools in the 1890s were attending all-female institutions, and even as late as 1926, 75% of the women members of the American College of Surgeons had graduated from these schools and trained and/or joined the staff of female-operated hospitals at some point in their careers.¹⁵ During the period that these schools remained open, it is estimated that they trained scores of women physicians many of whom had been rejected by all-male established schools and many of whom decided—in all likelihood—not to even try that route.

The seminal Flexner Report is of interest related to women’s medical colleges. It was commissioned by the Carnegie Foundation in 1910 to raise the standards of medical training in the United States, to include strict admission criteria of 4 years of college; rigorous and defined preclinical lectures and laboratory training in anatomy, physiology, and pathology among other subjects; and clinical training in hospitals with affiliation or close ties in most instances to a university system. Flexner’s systematic review of then existing regular and so called irregular (sectarian or eclectic) schools, some of which had trained women, led to the closure of most of the irregular schools. The report included a special section devoted to The Medical Education of Women. Flexner argued against separate medical schools for women and men. In his opinion: funds available for medical education of women would accomplish most if used to develop coeducational institutions, in which their benefits would be shared by men without loss to women students….¹⁶ History tells us that it would take some time for the world of medical educators to share his view.

Evidence for and Against a True Quota System

Three women were admitted to Northwestern Medical School , 10 years after it opened in Chicago in 1859, but they were not allowed to complete their studies as their presence allegedly disturbed their male student colleagues; no women were admitted again for another 60 years. In 1923, Elizabeth Montgomery Ward made a gift of $3 million for the building of a new medical campus in memory of her late husband A. Montgomery Ward, a highly successful Chicago retail entrepreneur. She expressed dismay upon learning that women were not being admitted to the Northwestern Medical School, and there was some concern that she would therefore not complete her gift. Wishing to be assured of the entirety of the donation, the Board of Trustees, after many meetings and discussions, voted to admit women to the medical school—but only after the new building was completed. A very similar scenario had played out some 30 years before in Baltimore where the prestigious Johns Hopkins University was experiencing significant financial difficulties. In 1889, the medical school was scheduled to open at the same time as the hospital, but the money that was to have come from the university’s railroad stock had dried up. Despite this, Hopkins trustees had hired four premier professors who showed up and found no school to teach in. Other prestigious schools of the day quickly sought to hire them. In desperation, leaders at Hopkins reportedly listened to the daughters of four of the original trustees: Martha Carey Thomas , Mary Elizabeth Garrett , Elizabeth King, and Mary Gwinn who were all unmarried, well-educated, and committed to causes of the feminist movement. They pledged to raise $500,000 needed to construct the building and open the school, but only if the school would admit qualified women on the same terms as men.¹⁷ The first woman was admitted to the medical school in 1893. Some of the male faculty of the institution resigned soon thereafter in what was later termed The Baltimore Capitulation.¹⁸ The admission of women to Northwestern and Johns Hopkins in those early days was considered by one historian to constitute women purchasing their way into medical school, and this idea, though cynical, could be a third way in which women confronted the active discrimination against their entry into training for the medical profession—in addition to seeking training abroad and establishing their own schools.

When the trustees of Northwestern Medical School agreed in 1923 that women would be admitted upon the same terms as men, there were conditions attached. As reported by Theilking, the school set a quota of only four women per class per year. Those in charge apparently thought it inadvisable to include men and women on the same dissection team—working together on naked bodies—in the anatomy lab required of first-year students. Traditionally in Anatomy Lab, four students worked around one table. The solution they developed was to separate women into their own work group. Four women started classes in 1926 with 100 other male first-year students.¹⁹ (Interestingly, 42 years later, in 1968, when I entered another medical school in the same city, in 1 of 6 students in a class of 80, 4 of us were assigned to one dissecting table—the cadaver was that of a woman, and the other 2 women had to be put with 2 male students at a dissecting table; men had been distributed to anatomy tables alphabetically by last name.) The creation of this quota system at Northwestern, which evolved as a practical solution, but was in reality a limited and small-minded concession, was not a new concept, as quotas had existed for African-American and Jewish students for many years in many types of institutions. The university continued to admit only a few women each year for the next 37 years. In an interview that appeared in a Northwestern University newsletter at the time of her 95th birthday, Dr. Margaret Gerber who was admitted to Northwestern in 1940, reported that when a professor of anatomy interviewed her for admission, he admitted that they knew how to pick men but had no idea how to pick women students. He was quoted as saying: when we pick women we just throw the applications in the air and the first four […to hit the ground] we take. Gerber considered herself fortunate to have had the luck of the drop.²⁰ According to Theilking’s review, the quota at Northwestern perpetuated the long-held belief that female students were not as valuable or deserving of a medical education as male students.²¹ This view was not borne out when the accomplishments of these early graduates were examined. (Two other vignettes included at the end of this chapter highlight the extraordinary accomplishments of women who obtained their medical degrees in the 1950s.) The quota at Northwestern quietly ended in 1963 when nine women were admitted to the incoming class. The number of women admitted continued to increase significantly at Northwestern and at schools throughout the United States over the next decades as discussed at length in Chaps. 2 and 3.

The report concerning the clearly stated quota system in place at Northwestern University was written well after the time that it occurred. Very little can be found in which medical schools specifically acknowledged that their limited admission of women was based on a quota. In 1991, an AMA publication intended as a comprehensive summary of the status of women in medicine in America stated in its introduction that "in 1946 the dean of a large medical school in the East admitted to limiting enrollment of women to 6%, and that even in 1960, women still faced small quotas when trying to enter medical schools."²² Lawrence Bloomgarden writing an extensive review that appeared in a 1953 issue of Commentary magazine described the quota that effectively limited the admission of Jewish students into medical schools.²³ Much of the detail in this review focused on New York schools, and he emphasizes that even though there was a shortage of physicians during the 1930s and after World War II, Jews made up on average 10% of the student body of the New York medical schools. He presented data from numerous studies, including details the effect of the Flexner Report on standardizing medical schools and greatly improving their quality, and he discussed the attempt of established schools to conceal their racial and religious-based quotas as geographic quotas set up in the name of diversity. Nowhere in the course of this extensively annotated report on quotas is there a mention of the admission of very limited numbers of women into these medical schools. He states his concern about the shortage of physicians graduating from medical schools, and there is no mention that educating women as physicians might help to alleviate the crisis he perceived.

There is one publication that comes up repeatedly in a search for documentation of quotas in the admission of women into medical schools in the United States in the mid-1900s. Stephen Cole , writing in 1986 in the Journal of Sociology attributes the low numbers of women in medical schools before the mid-1970s as primarily the result of differences in socialization-based occupational choice and not related to discrimination against women by medical schools. He states that in the past, medicine was considered to be an unsuitable occupation for women,²⁴ but he does not include reference to the extensive historical data about those in charge of medical colleges who argued that women were viewed as unsuitable for medicine on grounds of biology and temperament. He states that women may have internalized the societal attitudes concerning sex-appropriate careers and that in the past there were very few women who were interested in becoming physicians. He was perhaps not choosing to acknowledge the many-chronicled struggles of the strong committed women who did train as physicians through extraordinary persistence and despite decades of overt discrimination. In fact his paper devotes an entire section to what he calls The Walsh Hypothesis. He references Mary Roth Walsh’s seminal work Doctors Wanted: No Women Need Apply published in 1977 and accuses her of consistently referring to quotas used by medical schools, including specifically between the two world wars where quotas for women medical students averaged 5%. He repeats her assertion that "…women were not blocked by their inability to meet the increasing admissions requirements per se, but by those who controlled the system of medical education.²⁵ He argues that Walsh reported no data on the number of women applying to medical schools and infers that if she had she would not have attributed small numbers to discrimination. He states that women applying to medical schools during the time frame of 1929–1984 had just as good a chance of being accepted as men applicants," and he referred to available data from the Association of American Medical Colleges (AAMC) to support this. He utilized selected portions of this data, which were published yearly in the Journal of the American Association of Medial Colleges or in later years, in the Journal of Medical Education to create a discrimination index based on calculations made from the numbers of men and women applying to medical schools, the percentage of applicants by sex, and the percentage accepted by sex over the period of 1929–1984. Of interest, there is no data included for the years 1943–1949 when it has been shown that during the years of World War II when there were declining numbers of men entering medical schools, the numbers of women students and women graduates peaked at 9.5% and 12.1%, respectively, when before and after 1950, the percentages were in the 5–6% range.²⁶ This effect of low male student supply for medical schools during World War II is also discussed by Walsh who stated that the barriers to admission of women were on occasion lowered to solve a problem extraneous to the needs of women—such as a war or manpower shortage—but once the problem had been overcome, the barriers were again put in place. Using data from the education issues of the Journal of the America Medical Association, she notes that the number of women entering medical school increased from 259 in 1942 to 875 in 1945 (the year Harvard Medical School admitted 12 women!); in 1942, women represented 4.5% of the total medical school enrollment where in 1945 the number rose to 14.4%. Cole argues that it was not the lowering of barriers to women that increased their representation in medical school classes from 1945 to 1950 but perhaps the war itself that had the effect of increasing women’s interest in medical careers and that women were more likely to be encouraged to enter medicine out of patriotism! He states that he was primarily interested in understanding why the percentage of women entering medical school increased in the 1970s that he neither needed nor wished to argue that women were not discriminated against in the distant past. It is worth noting that in his analysis of percent of male and female applicants accepted in the years of his report (1929–1984), he does not state whether data from women’s medical colleges, primarily represented by Woman’s Medical College of Pennsylvania at that point, were included in his assessment; if they were, then the percentage of women applicants accepted would be artificially increased.

Walsh offers additional evidence for the existence of a quota system for admission of women to medical schools. She states that the question of whether schools had true quotas for women and minorities was often rejected or denied by individual institutions. She notes that decisions about admissions have always been closely guarded secrets and therefore difficult to access. (This is borne out in my own experience in attempting to locate records of admission committee meetings which at least in more recent years are inaccessible for privacy protection reasons; information from years before electronic records were instituted are in various formats on paper and often lost and/or not placed in university archives.) Walsh notes that by the 1950s, reference made in sociological journals to the traditional 5% quota on women students. She reports that as late as 1969–1970, four major schools, Albany Medical College, Yale University Medical School, Emory University Medical School, and Loyola Medical School, "openly expressed discriminatory policies toward women students in the handbook for prospective medical students published by the AAMC entitled Medical School Admission Requirements. She argues on the basis of data from a study done by the Women’s Bureau of the Department of Labor in 1968 that the mathematical consistency of the number of women accepted indicates that an internal quota system existed for each school (unpublished study). She also quotes statements from deans of prestigious medical colleges who when guaranteed anonymity admitted that quotas did exist. She includes reference to statements like Hell yes, we have a quota; and, yes, it is a small one. We do keep women out when we can. We do not want them here and they don’t want them elsewhere either, whether they’ll admit it or not."²⁷ Another medical school official described his school’s generous policy on the acceptance of women: "they did not want one woman to feel lonesome so they accepted two per class! A Special Subcommittee on Education, Discrimination Against Women of the 91st Congress in 1970 corroborated these statements, according to Walsh. This group also cited a survey of selected medical colleges in the northeast who admitted that they accepted men in preference to women unless the women applicants were demonstrably superior. Even Betty Friedan , beloved feminist icon, wrote in 1963 that by the 1950s a greater percentage of French women were obtaining advanced degrees as compared to American women and that there were five times as many women doctors proportionally in France. She states: our medical schools in the 1950’s made no secret of having quotas of 5% for women admissions: law schools were even lower."²⁸

Another intriguing source documenting a quota for women’s admission into medical schools appears in Jacalyn Duffin ’s presidential address to the Canadian Society for the History of Medicine’s annual meeting in 2000.²⁹ Prompted by her observation of the consistently small numbers of women appearing in the pictures of graduating medical school classes in the corridors of the University of Toronto where she entered premedical studies in 1968, as well as her own impression, she undertook a detailed investigation of the medical school archives. These conveniently included minutes of admission committee meetings from which she culled some interesting statements. She obtained data from literally counting the numbers of women in the composite graduation photographs (as I had done in my own institution before reading about her study). She collected the data from 1907 when the University of Toronto first admitted women to the mid-1970s and considered this the phenotypic arm of her study. This data revealed two pronounced increases in the numbers of women admitted to the medical school: immediately after both World Wars. Aside from those two peaks, she noted that on average the classes were made up of at least 85% men until the mid-1970s. In the archival arm of the study, she examined admissions committee reports to the medical school faculty council. In one report in 1942, there is a question raised as to whether there would be a continued quota for women and, if so, how could this quota be applied under existing regulations. In the years following World War II at the University of Toronto, there was a stated preference given to returning veterans, as was the case in US medical schools. However, in 1948, when there were only a few suitable veteran applicants, the question was again raised as to whether women applicants should be admitted. Duffin makes reference to the fact that the non-quota on women had been culturally inculcated at about 10%, and she cites a statement reportedly made by the dean of the Medical College to his friends and colleagues: …that he liked women medical students but that he was concerned that they would marry, have children, and waste their education, thus preventing a man from having a job. He argued that their numbers should be kept at 10%. Duffin had the opportunity to meet with one of her former teachers, Professor Jan Steiner, who had retired at that time of her study but had been involved in the admissions committee for the medical school for many years. He reported to her that Toronto had maintained a quota on women, Jews, and Catholics… for many years. He also states that the tripling of women medical student applicants during the period of the mid-1950s to 1973 … might well be attributed in part to the removal in 1967 of the quota limiting the number of women students.³⁰ Duffin was able to determine that the process the committee used in selecting students to be admitted before 1967 started by ranking applicants by marks (grades) and a measure of the applicant’s motivation for studying medicine. A ranking list was created and the committee moved down the list, accepting (or refusing) candidates until a secretary, always the same secretary, according to Steiner, would say, That’s it! Enough women. The remainder of the women on the list would be crossed out. This is as dramatic a documentation of the existence of as well as the procedure for carrying out a quota as can be obtained in the published data on the