Women Health Care Providers in Maryland: The Impact of Professionalization
Summary
The Women's Medical College of Baltimore was founded in 1882 by Baltimore women with the assistance of a few male doctors. The college thrived until 1910, when growing professionalization of medicine led to the school's closing. Lack of a salaried faculty and large laboratories undermined the college's reputation. When standard men's medical schools began to open their doors to women, the fate of the Baltimore college was sealed.
The professionalization of medicine in Maryland began at an early date. In 1799 the state legislature granted the Medical and Chirurgical Faculty (basically an association of doctors) the authority to license physicians. Though reports surfaced in 1811 indicating that the society was ineffective in enforcing the licensing scheme, attempts to control the profession languished through much of the rest of the century. Though an 1838 law allowed doctors to practice unlicensed, the General Assembly passed a physician licensing statute in 1888 calling for medical school graduates to have their diplomas verified and requiring doctors to pass an examination. Four years later the state legislature, with the encouragement of Dr. Ashby, one of the founders of the Women's Medical College, and other physicians, established a Board of Medical Examiners. To further its political power, the Medical and Chirurgical Faculty established a committee on legislation in 1894, and two years later, the legislature passed amendments to the licensing laws establishing a reporting system for unlicensed physicians and providing funds for enforcement.
Additional licensing changes were adopted in 1902. More detailed licensing requirements were imposed, fees were increased, and the Board of Medical Examiners was given the power to revoke licenses. The amendments also gave the American Medical Association the power to set the education requirements for obtaining a license. At about this time, the number of women medical students in the country peaked. Many of these students were clustered in Maryland. The states increasingly strict licensing requirements had not yet driven women out of the profession. Once regular medical schools began admitting women, however, the combination of accreditation, licensing, and restraints on midwifery forced the closure of the Women's Medical College.
Midwives were not included in licensing laws until an 1898 law required them to register with the local Registrar of Vital Statistics and file birth certificates. During this time the Medical and Chirurgical Faculty grew concerned with working with them to improve maternal and child health. Over time, the midwife registration law was amended to include requirements for licensing, examinations, and education. A few members wanted to eliminate midwives altogether, as had been done in other states, but they were in the minority.
An investigative committee published a report on midwives in Baltimore in 1909, reporting that the working environment discouraged good practices. The committee recommended supervision of midwives, qualifications for midwifery, and better registration procedures. They were not prejudiced against midwives, though their suggestions may have driven some out of practice. Dr. Ashby helped obtain passage of a midwife licensing bill after he was elected to the legislature, in 1910, which required literacy, training and the passing of exams to be a midwife. The stated goal was to improve, not eliminate midwifery. Nevertheless, between the 1890s and 1920s, the number of midwives fell as the professionalization of medicine grew.
As the number of women doctors and midwives fell, the number of nurses dramatically increased. In response, the legislature passed laws establishing a Board of Examiners for nurses, setting training requirements, and requiring exams and registration. Professionalization in medicine led to the creation of a hierarchy in the medical practice. Traditional views on gender roles caused men to fill the top positions in that hierarchy and women to fill the support roles. Nurses fit into this hierarchy; women's medical schools and midwives did not.
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