American medical women: the First World War and the meaning of war service, part 2, October 8, 1992

Kimberly Jensen: Because I have some slides we're going to use, partial lights. Speaker #1: Ready? Kimberly Jensen: Yeah. Speaker #3: [inaudible 00:00:21] Kimberly Jensen: And I've been told that this is not so you can kind of rest and go to sleep. That's not the reason why we have them this way. When we talk about women in the first World War, we usually think about pacifism and the suffrage campaign and these are both ways that women relate to the state, but if we use the prism of military service, we can really come to a more complex view of women's considerations of full citizenship and also women's relationship to war. These are certainly not questions that we're seeing for the first time today. We see Special Service Officer Neely is the first prisoner of war to be getting off the transports. Women in war have a long history and I'd like to talk a little bit about that with you today. As the United States prepared for and entered the World War in Europe in 1917, the status of the 6,000 women physicians in the country with respect to military service was uncertain. Few medical women had ever served in official military capacities. Several had been contract surgeons in the Civil and Spanish American Wars. Other women physicians had served as nurses, but now many women physicians, especially those most involved in the profession, believed that the wartime demand for medical personnel would allow them to enter the Medical Corps as officers and they formulated plans to push at the institutional boundaries of the military on many fronts during the war. Although they were ultimately unsuccessful in their efforts to gain commissions, an analysis of their claims and activities reveals the inner section of the ideological and practical concerns of these medical women as citizens, as members of the medical profession, and also as women. As war was juxtaposed with the campaign for women's franchise ... And for those of us who need a refresher, the 1910s is really a climax of the campaign for women's suffrage in America, and the 19th Amendment is granted in 1920, right after the war. These women developed an ideology of full women's citizenship, which included the traditional citizen's obligation of military service. As war placed the medical profession on the public stage, they made a claim for equal status and equal opportunity for service within the Medical Corps to sustain the promise of professional equality during the conflict and in the postwar medical world. For many of these medical women, a vision of civic and professional equality did not preclude the incorporation of what they considered to be women's priorities into their vision of medical wartime service. So, difference and equality are held in the same hand in some ways. Women physicians made their wartime claims for equal opportunity in the context of a broader history of struggle for access to educational, professional, and organizational opportunity in the field of medicine, as we've learned from Regina Morantz-Sanchez in Sympathy and Science, and Mary Roth Walsh in Doctors Wanted: Women Need Not Apply. The 1910s was a time for optimism for many medical women. As the nation entered the war, women physicians could point to progress in educational opportunity and in occupational variety, but there were still many reforms to be made, of course, especially in access to medical education for African American women and other women of color, and in internship and professional opportunities for all women. The Census reports that 6% of the physicians and surgeons in the United States in 1910 were women. Six percent. This was the largest percentage and the greatest number of women physicians that had ever been in service and was a peak not reached again until 1950. Now, in 1910, 84 of these women physicians in 1910 were white and born in the United States, 12% were white and born outside the United States, 4% were African American, and less than 1% were Native American, Asian, or from other cultural groups. Since I'm focusing on the quest for war service today, the other material that I have about African American women physicians isn't in here, but please ask me afterward. Women physicians represented only 4% of all women healthcare workers reported in the 1910 Census. Untrained nurses, by far the largest category, made up 54% of the total, and trained nurses 37%. The story of women nurses is, of course, another chapter. Midwives followed women physicians with 3% of the total and women designated as healers made up 2% of women healthcare workers. A 1916 study showed that over 1,000 American women physicians in active practice were specializing. Two-thirds did so in what were considered women's specialties, and these are up at the top, such as obstetrics and gynecology. One-third, however, were making inroads into fields considered to be male territory. Two professional events for women physicians in the decade prior to the first World War had important consequences for the organization of women's physicians during the war. Women were vital members of the Public Health Committee of the AMA, the American Medical Association, which operated from 1909 to 1913, and a professional organization for women physicians and surgeons, the Medical Women's National Association, today we know that as AMWA, the American Medical Women's Association, was formed in 1915. Through each of these groups, women gained power with unified action, created important networks, and presented themselves as organized and purposeful groups to their male colleagues and to the public. Medical women constructed their case for a place within the military Medical Corps at the same time that male physicians were waging their own battle with the military for increased rank and authority. This wartime legislative campaign, led by medical leaders under the direction of Dr. Franklin Martin of the General Medical Board of the Council of National Defense, was waged for almost the entire length of the war itself and was finally successful when the Owen-Dyer Bill was passed in both Houses of Congress in July 1918. Officers in the Medical Corps were then given the same status as other military officers in the regular Army and increased authority in sanitary regulations and recommendations. The confluence of wartime need and the struggle for change on the part of the medical profession made the construction of a reform moment possible. Would women physicians be part of such reforms? How might they construct their case for inclusion? How would they confront the boundaries between women and military service with which other women interested in such service were grappling? In June 1917, three months after the United States entered the war, the members of the Medical Women's National Association assembled at their second annual meeting in New York City. A purposeful audience unanimously approved, unanimously approved a resolution by California women physicians to be sent to Secretary of War Newton D. Baker, calling for acceptance of women in the military Medical Corps on equal terms with men. In this atmosphere of enthusiasm for the possibilities of medical women's war service, the members present also supported the creation of a war service committee, which they hoped would translate their desire for service and recognition into concrete plans and positive results. I might just say as an aside here that African American physicians are doing the same thing. They create a war service committee for the same goals. Rosalie Slaughter Morton, a New York surgeon who had visited and served at the war front in Serbia, was chosen to chair the committee. She gave it a new name, the American Women's Hospitals, binding the new group to the strength and accomplishment of the Scottish Women's Hospitals already in service at the front. Soon after the American Women's Hospitals was organized, Dr. Franklin Martin asked Morton to chair a committee of women physicians for the General Medical Board of the Council of National Defense in Washington. Morton considered the appointment to be an opportunity to expand the authority of the American Women's Hospitals. She selected prominent medical women who were serving on American Women's Hospital's committees for appointment to this new committee. And at the first meeting of the General Medical Board, which she attended as chair of the Committee of Women Physicians, Morton acted on her philosophy, that the Committee of Women Physicians was under the authority of the American Women's Hospitals, which in turn drew its authority from the medical women of the country and properly represented them. Morton told members of the General Medical Board that the American Women's Hospitals was to be the clearinghouse for the war service and activities of all the medical women of the country. She asked Franklin Martin to read a resolution that she had prepared, which stated that "no units of women or individuals to substitute for or relieve others in hospitals will be accepted for service unless endorsed by the American Women's Hospitals". Franklin Martin and other male members of the General Medical Board constructed the lines of authority in a completely different way. As Martin phrased it, "One little matter had to be ironed out at this meeting." Any sort of clearinghouse for the work of medical women would properly come, he said, under the General Medical Board with its committee of women physicians. It was the men of the General Medical Board who had the ultimate authority in matters concerning women physicians, he believed, not the American Women's Hospitals nor the medical women represented by that organization. "This view prevailed," Martin wrote succinctly. "And no action was taken upon the resolution." Some board members talked of abolishing the women's committee and of blocking the plans of the American Women's Hospitals. While these actions were never taken, the Committee of Women Physicians became a nominal organization of women that was controlled by men. Consequently, the Committee of Women Physicians was never considered to be a powerful body by either men or women in the country. Medical women maintained their seats on the committee to keep them occupied, but largely focused their wartime efforts on behalf of women physicians elsewhere. Following the unanimous adoption of the resolution calling for women's acceptance into the Medical Corps at the Medical Women's National Association annual meeting, the resolution was widely circulated in the form of a petition to Secretary of War, Newton D. Baker. Bertha Van Hoosen, president of the Medical Women's National Association, recalled that "weeks later, the huge petition rolled into New York City like a full-term pregnancy" to be delivered to Baker by the leaders of the American Women's Hospitals. Washington officials received numerous letters and other inquiries regarding women in the Medical Corps and many women sent in their applications for acceptance to the Medical Reserve Corps of the Army. Van Hoosen and other prominent physicians made personal visits that summer and prominent non-medical women and men urged Surgeon General William Crawford Gorgas and Secretary of War Baker to admit women physicians in the Medical Corps on equal terms with men. At the same time, medical men were developing their own campaign, as we've seen, for increased status within the military. Pressure from many sides mounted. What would the military do about women physicians? One official avenue for women's military service existed. Several women had served as contract surgeons, including Dr. Anita Newcomb McGee, who later became the head of the Army Nurse Corps. Yet most women opposed such work, women physicians. For Carolyn Purnell contract work would mean "our ability to be under the cook, the head nurse, or others, and be ordered around." Following a trip west, Chicago physician Martha Welpton reported that "very few of the coast women and few of the Colorado women also will go as contract surgeons. They object to it with all their might." Chicago women believed that their professional dignity was at stake and absolutely opposed contract service. For these and other medical women across the country, contract service in the military represented acceptance of inferior status based on gender. Physicians in the Civil War had been employed as contract surgeons performing part-time work. "The individual doctor, so employed, maintaining his own private practice at home and at the same time giving some hours of each day to his Army hospital duties." And the word "his" applies to men. Since the Civil War, male physicians had achieved increased rank and status within the Army and were struggling for more. The position of a contract surgeon seemed now to be what was termed a curiosity or an anachronism, one which lacked any rank, professional prestige, or the authority to command deference. The Surgeon General still had the power in regulations to appoint as many contract surgeons as might be needed in emergencies and at places which did not justify the expense involved by the detail of a medical officer. Only two men served with the American Expeditionary Forces as contract surgeons. The other 887 men employed during the war years as contract surgeons served on the home front in part-time limited capacities. Chicago neurologist Peter Basso, for example, contracted with the Army to teach a course in neurosurgery, and he was called a contract surgeon. In response to pressure regarding women's medical service in the first World War, a new purpose for contract service was articulated by the government. In August 1917, acting Judge Advocate General Blanton Winship handed down his interpretation of military regulations regarding contract surgeons. "The statute does not prescribe that contract surgeons shall be males," he wrote. "And, in the absence of such a limitation, I am clearly of the opinion that it is allowable by law to appoint female physicians as contract surgeons in the United States Army." For many medical women, this was nothing more than an attempt to create a separate and unequal category of military service for women physicians. The regulations dealing with service in the regular Medical Corps contained the same phraseology as did those outlining the qualifications for contract work. They both spoke of citizens, yet that same month, the acting Judge Advocate General interpreted the regular Medical Corps regulations to pertain solely to men. It seemed that while women would be accepted only as what many termed day laborers, men would be given the status, rank, and pay of officers in the Medical Corps. Carolyn Purnell, a Philadelphia Surgeon, answered those who argued that contract practice was a step along the road to equality in military service. "As a woman, as a physician, and as a surgeon," she said. "I think our days for crawling are over. I cannot see why women should demonstrate their patriotism in any different way from men. If the men respect themselves and demonstrate their patriotism according to their training and experience, why should not women do the same thing? Why should we have to have a different way when our ability is just the same? We would be more self-respecting if we should stand upon this. Our brains are not in our sex." Purnell advocated a boycott of contract practice and, apparently, the majority of medical women in the country agreed. In the fall of 1917, Dr. Carolyn [inaudible 00:15:34] of Baltimore was attempting to register medical women's opinions on such service. She wrote to the Medical Women's Club of Chicago that most women surveyed answered negatively to the question, "As the only manner of serving, would you consider contract practice, if this form of service can be made less objectionable?" Some women held notions of patriotism and professionalism that allowed them to see contract service with the military in a more positive light. Such service would make it possible for them to use their professional skills to serve their country, the wounded, and the sick without delay. Some believed that if contract practice was the place where women could push at the boundaries of military service, then they would join and push. A few women found contract service to be the only way that they could circumvent military restrictions and still serve as members of the hospital units that they had joined for overseas work. Physician Esther Pohl Lovejoy, who later compiled their history, summed it up. "They were without commissions," she wrote. "But they were on the job." Over the course of the war, 55 medical women engaged in contract practice with the United States Army. They came from all parts of the country and from urban areas like Brooklyn, Boston, and San Francisco, as well as smaller towns and rural communities. They had been educated at both large and small medical institutions, and while over half graduated from medical school after 1908, they represented a range of age groups. 11 women served as contract surgeons overseas. Frances Edith Haynes of Chicago worked as an anesthetist with her medical unit at Limoges, France. Cincinnati physician Elizabeth van Cortlandt Hocker entered the Army as a contract surgeon in May 1918, and served until August 1919. She was particularly proud that after the Armistice in November 1918, she was placed in charge of two hospital wards of 42 beds each that were for women personnel of the Army at Savenay, France. 44, or 80%, of women contract surgeons performed their military duties while remaining in U.S. territory. Some serving in administrative posts and others at military hospitals and many caring for convalescent soldiers. Physician Dolores M. Piñero received her medical degree in Puerto Rico and was practicing in the town of Rio Piedras when the war began. She became a contract surgeon with the Army in October 1918 and was immediately assigned to the base hospital at San Juan where she provided psychiatric care for disabled soldiers and military dependents. Her contract lasted for three months until January 1919. She then returned to her civilian practice at the psychiatric hospital in Rio Piedras. At least two groups of women and many others as individuals sought to enter the medical department as officers by direct application, taking the position that they were the citizens that were eligible for service as stated in military regulations. Here they followed the interpretive and practical strategies of Susan B. Anthony, Virginia Minor, and other late 19th century suffrage activists who presented themselves at the polls as citizens eligible to vote under the protection of the 14th Amendment, which established the definition of citizens as "all persons born or naturalized in the United States". Now, these medical women, many of whom lived in states that granted women the right to vote by 1917, took up the cause of defining women's citizenship rights and obligations and challenged their exclusion as citizens from military service to the state. One group to claim the status of citizenship through such direct action consisted of four Portland, Oregon, medical women who drove to the Vancouver, Washington, training facility for medical officers in the Spring of 1918, to present themselves as eligible physicians desiring commissions as medical officers. Doctors Katherine Manion, Mae Cardwell, Mary MacLachlan, and Emily Balcom came representing many other women physicians of the area. "There is no word in the War Department regulations that bars women," one of them told a reporter for the Portland Journal after their attempt. "And away we went to the medical officers training camp." They presented themselves to an astonished major in charge of the camp. "Ready and armed to take the examinations, don the uniforms, and salute the privates," they said. The four women stated their intentions, arguing that in their community women had full suffrage, that they were citizens and ready to meet the professional and other requirements necessary for acceptance into the Medical Reserve Corps. They brought with them the necessary documents. After checking these, the major told the group that he could not examine them because "it hasn't been done." After more discussion, he asked them if they wouldn't like to go overseas as nurses. They firmly replied that they would not and asked the male physician officer, "Would you?" The major finally said that he would telegraph Surgeon General Gorgas for an answer and the negative reply came from Washington the next day. Another coalition constructed a more elaborate test case to assert the right of medical women as citizens and trained physicians to serve as medical officers in the military. The newly formed Colorado Medical Women's War Service League, that's a mouthful, met in September 1917 and created a committee on recognition of medical women. Mary Elizabeth Bates, a prominent Denver gynecologist, Medical Women's National Association officer, suffrage activist, community organizer, and secretary of the League, was asked to chair the committee and "to take up the question of the appointment of women physicians in the Medical Reserve Corps of the U.S. Army." The committee had two tasks. First, to identify and study the regulations governing the service of physicians in the medical department of the Army. Then second, to recommend and implement the actions necessary for women physicians to gain equal access to the medical corps. Bates and her committee members began an investigation of the status of the regulations concerning service with the Medical Reserve Corps. The manual for the medical department required applicants for the Medical Corps to be "between 22 and 30 years of age, a citizen of the United States. Must have a satisfactory general education, must be a graduate of a reputable medical school legally authorized to confer the degree of Doctor of Medicine, and must have had at least one year's experience in hospital training including practical experience in the practice of medicine, surgery, and obstetrics." Gender was not an explicit category for acceptance in the regulations and there were hundreds of women, if not thousands, who could meet the professional and physical qualifications necessary for service. Based on their examination of military regulations, Bates and her committee concluded, "the word citizens must include women since women are citizens." In the opinion of the committee, it was obviously not necessary to seek the enactment of a law to permit the appointment of women. Unlike nurses who needed to get new legislation passed to allow them as a professional group to gain officer status in the war, medical women had to deal with the interpretation of laws that, in explicit language at least, were not gender specific, and already granted officer status to their professional group. Yet, the interpretation of a law could be just as powerful as the absence or presence of a law. On 30th of August 1917, acting Judge Advocate General S. T. Ansell had written an official interpretation of military regulations regarding the service of women physicians in the Medical Reserve Corps. This is the same time that contract practice is being interpreted as being available to women. His interpretation was based on the same premise as the actions of the major in Vancouver. "It hasn't been done." But his decision had much more powerful consequences because it was supported by legal precedent and the authority of his office. After quoting precedent, Ansell ruled that "it is the view of this office that it is not allowable by law to appoint female positions to military office in the medical section of the Officers' Reserve Corps of the Army." In the body of his decision, the Judge Advocate General stated four main reasons why, in his opinion, women physicians should not be commissioned as officers in the Medical Reserve Corps. Women physicians could not serve because they had not done so in the past. Soldiers were specified as men in other regulations not affecting the medical department. These were for Marines and Seamen. And women would not be physically capable. And fourth, they were not to have the status of officers by which they would command men. Mary Bates and her committee developed, along with their ally Senator John Franklin Shafroth of Colorado, a plan to test the Medical Corps regulations that called for the appointment of citizens. "A plan", Bates wrote, "that would achieve the result desired with the minimum amount of trouble for the War Department." The league would select from six to 12 women physicians who would apply as a group for service with the Medical Reserve Corps. The medical women in this test case were to come from states that granted women the right of suffrage, presumably because women in these states had already crossed an important conceptual boundary of citizenship. These women were to be professionally prepared and have all the qualifications necessary to "make good" if appointed to the Medical Reserve Corps. Along with the standard documentation of education and accomplishments, the women were to secure recommendations from prominent and influential persons and senators and representatives from their states were to be enlisted in the cause. They wanted to cover all the bases. Senator Shafroth from Colorado was very enthusiastic about the plan and the alliance between Shafroth and women working for the cause of citizenship was an enduring one. The suffrage journal the Woman Citizen recalled, "He helped Miss Anthony, Susan B. Anthony, in the days when he was almost the only friend suffrage had in Congress." By February 1918, the applications of eight representative women physicians were in order and the test case was put in motion. A group of 11 members of Congress, led by Shafroth, went to the office of Surgeon General Gorgas. Anita Newcomb McGee, who had served as a contract surgeon in the Spanish American War and had been appointed head of the Army Nurse Corps in 1901, accompanied the delegation. As the woman physician most closely associated with actual experience in military medicine, McGee's presence was both symbolic and practical. In her account of the proceedings McGee reported that the application of Mary Bates was included with those of the other eight women and all were presented to the Surgeon General for his approval. By all accounts, Gorgas was very sympathetic with the movement. He told McGee that he personally favored commission for women physicians, but he was bound by the decision of the Judge Advocate General, and he suggested that they take their cause to the Secretary of War. On February 4th, the group met with Secretary of War Baker whose views on women in military service had already been publicly expressed. In a letter to the military committees of both houses of Congress in the fall of 1917 that were considering a bill to commission women in the Signal Corps, Baker wrote that he did not approve of commissioning or enlisting women in the military service. Period. The group presented the women's applications to Baker, read the decision of the Judge Advocate General, and explained their position in the matter. Baker replied that his main thought was to win the war and that he did not think that commissioning women physicians would contribute to that end nor did he want to make any unnecessary innovations now. Shafroth and McGee both argued that there was a need for the service of women physicians, McGee stating that the Surgeon General himself wanted them especially for work as anesthetists and pathologists. Baker terminated their conversation saying that he believed women physicians were not needed by the military, but that he would consider the matter further. The test case was at a stand still with the applications shelved in the office of the Secretary of War. Medical women also mounted a campaign to bring the question of women's entrance in the Medical Corps to the formal attention of the American Medical Association, after which they hoped the association would act to support commissions for women physicians. They were successful in achieving a voice, although a voice filtered through male allies, at the AMA national convention in Chicago in June 1918. Here, three resolutions supporting commissions for women physicians were introduced and made their way to committee. The language contained in these three AMA resolutions reveals a great deal about the way in which medical women and their allies constructed a pace for women's service. In a broad sense, medical women employed the same two arguments that Eileen Kraditor has identified as the basic rationales in the call for women suffrage, expediency and justice. According to the AMA resolutions, and I'm quoting from all three here, "it would be expedient for the government to commission women physicians. They were fitted and equipped to provide valuable service. They were graduates of medical schools and qualified to practice medicine. And most," one said, "If not all of them have signified their readiness for service." "With the demands of war, all available skill should be utilized and commissions would," in the words of another one, "further the utilization of women physicians in service." The resolutions also called for women's entrance into the Medical Corps based on the idea of justice. "Women physicians in all fields, including surgery," one resolution emphasized, "render service as efficient and valuable as can be rendered by men." Medical women already serving overseas with such groups as the Red Cross had performed invaluable services and demonstrated their loyalty "employing," in the words of another resolution, "their skill and energy in our common cause." For these reasons, the resolutions called upon the Secretary of War to bring women physicians into the Medical Corps in full standing with the same rank and pay as male medical officers. Medical women also address objections to service based on a supposed physical weakness or unsuitability for military service. "American women physicians serving in the war zone with the Red Cross and other organizations and women physicians from other nations," one resolution stated, "have demonstrated that it is possible for women to endure the hardships of life in the war zone and still do creditable work." Here, as well as in the other aspects of their argument, they made the implicit claim for service as citizens who were equal in their abilities to serve the state even while facing the dangers of the war zone. The resolutions were forwarded to the Reference Committee on Legislation and Political Action for the AMA. This committee returned an opinion that appeared to be both supportive and cautious and drew the line for women service at the boundary of soldiering. "The very character of military service and women's natural limitation for such service must require wise discrimination in their employment in war work," the committee members wrote. Women physicians, in other words, were not to be front line soldiers or on the battlefield due to the natural limitations of gender. "However," they continued. "The principle of equal rank and pay for equal service is inherently just without regard to sex and the committee feels that this should be unhesitatingly approved by the House of Delegates of the AMA." According to this AMA committee, women physicians could serve in the military without actually being soldiers and therefore they avoided the issue of women's military service as combat service, a threshold most Americans were unwilling to cross. Yet, by denying them soldier status, the AMA also perpetuated the less than equal place for women in the Medical Corps. As Ruth Milkman has shown in her study of the relationship between male and female workers in the auto and electrical industries in World War II-