Book Review

To the Ends of the Earth: Women's Search for Education in Medicine

N Engl J Med 1993; 328:361-362February 4, 1993

Article

To the Ends of the Earth: Women's Search for Education in Medicine
By Thomas Neville Bonner. 232 pp., illustrated. Cambridge, Mass., Harvard University Press, 1992. $34.95. ISBN: 0-674-89303-4

To the Ends of the Earth is an encyclopedic history of migration, courage, and frustration in which Bonner recounts the attempts of women to obtain a medical education in Europe and the United States since the late 1840s. While the author, an academic historian, was conducting research on American doctors in European universities before 1914, he “came upon the remarkable number of foreign women, including Americans, who were enrolled in medicine in Zurich, Bern, Paris, and Geneva.” From this serendipitous beginning, he has assembled a detailed, thoroughly annotated, data-rich account of women's struggles to obtain a medical education.

The most prominent aspect of the history of women's efforts to become physicians is the number of shifting battlefields on which they have had to fight. Schools in one country would accept women as students in coeducational classes, whereas those in other countries would not. Schools would accept women for a time and then refuse to accept any more. One university in a country might accept women while another in the same country would not. A medical school might accept a woman student, but clinical opportunities in hospitals would be denied.

Interwoven in this shifting scene were the appearance and disappearance of women's medical colleges and offerings of separate classes for women. The University of Michigan, braver than most other U.S. schools, began accepting women in 1870, but for the next 11 years the faculty gave separate lectures and demonstrations to the women. By 1881 more than 20 percent of the students were women and the regents decided to allow the faculty to decide whether or not to repeat all the lectures for the women students. Subsequently, anatomy continued to be taught separately, but walls were said to give way to curtains in some classes, and a red line sufficed to delineate the proper placement of women in others. Most U.S. medical schools shied away from even this limited risk. It remains unclear whether the motivation for these restrictions or exclusions was to protect the men students from the women, the women students from the men, or the faculty from the embarrassment of lecturing to a classroom of mixed sexes.

Bonner's analysis of factors that might explain the shifting representation of women over time in different countries is as interesting as his data. For example, it appears that the devastation of World Wars I and II had more to do with the acceptance of women in the medical profession than intellectual acceptance of their capabilities, even though these had been repeatedly established. At the end of World War II women in the Soviet Union occupied 80 percent of medical-student positions. In France, Germany, and Britain more than 25 percent of medical students were women. In the United States, which had the fewest wartime casualties, only 8 percent of medical students were women in 1945. The author also makes the observation that countries with private medical schools and licensing boards were able to restrict admission far longer than those with schools under state control.

One small problem for the reader arises from the fact that much of the book is organized by geography -- i.e., by the countries to which and from which women moved to find a medical education that did not entail insurmountable hurdles to admission or graduation. Women's biographical accounts appear and reappear in different chapters depending on whether their country of origin or of destination is being described. To make this extraordinary account readable, the reader should start with the epilogue, which places the turmoil in perspective and conveys the intrinsic drama of the story. Although the stage has shifted from medical education to the representation of women on medical faculties, the story of more than 100 years of attempts by women to gain access to high-quality medical education needs to be told, for some of the same arguments and obstacles crop up when faculty positions are considered today.

This book should be considered an essential reference for anyone studying the historical, social, economic, and psychological currents that affected many countries' ability to make full use of the talent of half the potential candidates for a medical education. It is also a tribute to the women in many countries who persisted, against extraordinary odds, in pursuing a profession that they found irresistibly challenging and gratifying.

Eleanor G. Shore, M.D.
Harvard Medical School, Boston, MA 02115