We have not been passive bystanders in the history of medicine. The present system was born in and shaped by the competition between male and female healers. The medical profession in particular is not just another institution which happens to discriminate against us: It is a fortress designed and erected to exclude us. This means to us that the sexism of the health system is not incidental, not just the reflection of the sexism of society in general or the sexism of individual doctors. It is historically older than medical science itself; it is deep-rooted, institutional sexism. If nursing was not exactly an attractive field to women workers, it was a wide open arena for women reformers. To reform hospital care, you had to reform nursing, and to make nursing acceptable to doctors and to women of “good character,” it had to be given a completely new image. Florence Nightingale got her chance in the battle-front hospitals of the Crimean War, where she replaced the old camp-follower “nurses” with a bevy of disciplined, sober, middle-aged ladies. Dorothea Dix, an American hospital reformer, introduced the new breed of nurses in the Union hospitals of the Civil War.

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The US in 1800 could hardly have been a more unpromising environment for the development of a medical profession, or any profession, for that matter. Few formally trained physicians had emigrated here from Europe. There were very few schools of medicine in America and very few institutions of higher learning altogether. The general public, fresh from a war of national liberation, was hostile to professionalism and “foreign” elitisms of any type. The lay practitioners were undoubtedly safer and more effective than the “regulars.” They preferred mild herbal medications, dietary changes and hand-holding to heroic interventions. Maybe they didn’t know any more than the “regulars,” but at least they were less likely to do the patient harm. Left alone, they might well have displaced the “regular” doctors with even middle class consumers in time. But they didn’t know the right people. The “regulars,” with their close ties to the upper class, had legislative clout. By 1830, 13 states had passed medical licensing laws outlawing “irregular” practice and establishing the “regulars” as the only legal healers. The question is not so much how women got “left out” of medicine and left with nursing, but how did these categories arise at all? To put it another way: How did one particular set of healers, who happened to be male, white and middle class, manage to oust all the competing folk healers, midwives and other practitioners who had dominated the American medical scene in the early 1800s? It was a political struggle, second, in that it was part of a class struggle. Women healers were people’s doctors, and their medicine was part of a people’s subculture. To this very day women’s medical practice has thrived in the midst of rebellious lower class movements which have struggled to be free from the established authorities. Male professionals, on the other hand, served the ruling class – both medically and politically. Their interests have been advanced by the universities, the philanthropic foundations and the law. They owe their victory – not so much to their own efforts – but to the intervention of the ruling class they served.

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But, despite the glamorous “lady with the lamp” image, most of nursing work was just low-paid, heavy-duty housework. Before long, most nursing schools were attracting only women from working class and lower middle class homes, whose only other options were factory or clerical work. But the philosophy of nursing education did not change – after all, the educators were still middle and upper class women. If anything, they toughened their insistence on lady-like character development, and the socialization of nurses became what it has been for most of the 20th century: the imposition of upper class cultural values on working class women. (For example, until recently, most nursing students were taught such upper class graces as tea pouring, art appreciation, etc. Practical nurses are still taught to wear girdles, use make-up, and in general mimic the behavior of a “better” class of women.) Witches lived and were burned long before the development of modern medical technology. The great majority of them were lay healers serving the peasant population, and their suppression marks one of the opening struggles in the history of man’s suppression of women as healers. Women made up some 85 percent of those executed – old women, young women and children. [We are omitting from this discussion any mention of the New England witch trials in the 1600s. These trials occurred on a relatively small scale, very late in the history of witch-hunts, and in an entirely different social context than the earlier European witch-craze.] Now the motive of the will is something perceived through the senses or the intellect, both of which are subject to the power of the devil. For St. Augustine says in Book 83: This evil, which is of the devil, creeps in by all the sensual approaches; he places himself in figures, he adapts himself to colors, he attaches himself to sounds, he lurks in angry and wrongful conversation, he abides in smells, he impregnates with flavours and fills with certain exhalations all the channels of the understanding. The new nurse – “the lady with the lamp,” selflessly tending the wounded – caught the popular imagination. Real nursing schools began to appear in England right after the Crimean War, and in the US right after the Civil War. At the same time, the number of hospitals began to increase to keep pace with the needs of medical education. Medical students needed hospitals to train in; good hospitals, as the doctors were learning, needed good nurses.

Witches, Midwives and Nurses: A History of Women Healers

Two of the most common theories of the witch hunts are basically medical interpretations, attributing the witch craze to unexplainable outbreaks of mass hysteria. One version has it that the peasantry went mad. According to this, the witch-craze was an epidemic of mass hatred and panic cast in images of a blood-lusty peasant mob bearing flaming torches. Another psychiatric interpretation holds that the witches themselves were insane. One authoritative psychiatric historian, Gregory Zilboorg, wrote that: Six witnesses affirmed that Jacoba had cured them, even after numerous doctors had given up, and one patient declared that she was wiser in the art of surgery and medicine than any master physician or surgeon in Paris. But these testimonials were used against her, for the charge was not that she was incompetent, but that – as a woman – she dared to cure at all. The witch-healer’s methods were as great a threat (to the Catholic Church, if not the Protestant) as her results, for the witch was an empiricist: She relied on her senses rather than on faith or doctrine, she believed in trial and error, cause and effect. Her attitude was not religiously passive, but actively inquiring. She trusted her ability to find ways to deal with disease, pregnancy and childbirth – whether through medications or charms. In short, her magic was the science of her time.

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The other side of the suppression of witches as healers was the creation of a new male medical profession, under the protection and patronage of the ruling classes. This new European medical profession played an important role in the witch-hunts, supporting the witches’ persecutors with “medical” reasoning:

Witches, Midwives, and Nurses by Barbara Ehrenreich and Witches, Midwives, and Nurses by Barbara Ehrenreich and

In Western Europe, university-trained physicians already had a centuries’ old monopoly over the right to heal. But in America, medical practice was traditionally open to anyone who could demonstrate healing skills – regardless of formal training, race or sex. Ann Hutchinson, the dissenting religious leader of the 1600s, was a practitioner of “general physik,” as were many other ministers and their wives. The medical historian Joseph Kett reports that “one of the most respected medical men in late 18th century Windsor, Connecticut, for example, was a freed Negro called “Dr. Primus.” In New Jersey, medical practice, except in extraordinary cases, was mainly in the hands of women as late as 1818...”Our oppression as women health workers today is inextricably linked to our oppression as women. Nursing, our predominate role in the health system, is simply a workplace extension of our roles as wife and mother. The nurse is socialized to believe that rebellion violates not only her “professionalism,” but her very femininity. This means that the male medical elite has a very special stake in the maintenance of sexism in the society at large: Doctors are the bosses in an industry where the workers are primarily women. Sexism in the society at large insures that the female majority of the health workforce are “good” workers – docile and passive. Take away sexism and you take away one of the mainstays of the health hierarchy. Just as the feminist movement had not opposed the rise of medical professionalism, it did not challenge nursing as an oppressive female role. In fact, feminists of the late 19th century were themselves beginning to celebrate the nurse/mother image of femininity. The American women’s movement had given up the struggle for full sexual equality to focus exclusively on the vote, and to get it, they were ready to adopt the most sexist tenets of Victorian ideology: Women need the vote, they argued, not because they are human, but because they are Mothers. “Woman is the mother of the race,” gushed Boston feminist Julia Ward Howe, “the guardian of its helpless infancy, its earliest teacher, its most zealous champion. Woman is also the homemaker, upon her devolve the details which bless and beautify family life.” And so on in paeans too painful to quote. The partnership between Church, State and medical profession reached full bloom in the witch trials. The doctor was held up the medical “expert,” giving an aura of science to the whole proceeding. He was asked to make judgments about whether certain women were witches and whether certain afflictions had been caused by witchcraft. The Malleus says: “And if it is asked how it is possible to distinguish whether an illness is caused by witchcraft or by some natural physical defect, we answer that the first [way] is by means of the judgment of doctors...” [Emphasis added]. In the witch-hunts, the Church explicitly legitimized the doctors’ professionalism, denouncing non-professional healing as equivalent to heresy: “If a woman dare to cure without having studied she is a witch and must die.” (Of course, there wasn’t any way for a woman to study.) Finally, the witch craze provided a handy excuse for the doctor’s failings in everyday practice: Anything he couldn’t cure was obviously the result of sorcery.