The International History of Women’s Medical Education: What Does Imperialism Have To Do With It?

For the past several years, this 1885 photograph of three medical students who attended the Woman’s Medical College of Pennsylvania (WMCP) has been circulating around the Internet. The students pictured above are, from left to right, Anandibai Joshee, Keiko Okami, and Sabat Islambooly (whose name is misspelled in the original text accompanying the photograph). Because these women were medical students in an era when Asian women experienced near-universal oppression, according to popular narratives, this photograph appears striking to audiences. Yet Islambooly, Joshee, and Okami were not quite as exceptional as this single photograph may indicate.

From 1885 to 1915, more than twenty women from Asia, Latin America, and the Middle East attended the College, and many more would attend after 1915. Their mostly untold stories are the subject of my dissertation, “Educating Women Physicians of the World: International Students of the Woman’s Medical College of Pennsylvania, 1883-1911.”¹

In popular discourse surrounding the photograph of Joshee, Okami, and Islambooly, interpretations of their historical significance have often been misleading. When Public Radio Initiative (PRI) ran a story inspired by the photo in 2013, journalist Christopher Woolf suggested that the photograph evidenced the exceptionality of the United States. Woolf wrote, “It’s a reminder just how exceptional America was in the 19th century. We often spend so much time remembering all the legitimately bad things in US history. But compared to the rest of the world, America was this inspirational beacon of freedom and equality.” According to Woolf, Joshee, Okami, and Islambooly present a refreshing antidote to more critical histories of the U.S., presumably those tending to emphasize slavery, dispossession of indigenous people, and wars in foreign countries that later proved unpopular with the American public. However, while Woolf’s narrative may be comfortable for those looking to celebrate America, it obscures a more complicated story about why these three women were together in Philadelphia in 1885.

Women in the U.S. were able to study medicine earlier and in greater numbers as compared to other countries. But was the relative availability necessarily rooted in American respect for freedom and liberty? According to Thomas Bonner, who has conducted a comparative study of women’s medical education around the world, it is more likely that the relative laxness of standards in American medical education throughout the nineteenth century opened up the door for women’s entrance. A lack of regulatory mechanisms permitted a handful of radical individuals to create separate medical colleges for women. WMCP, founded in 1850 by liberal Quaker male physicians in Philadelphia, was a primary exemplar of this kind of separate women’s institution.²

Additionally, Regina Morantz-Sanchez has suggested that medicine’s status as a healing art, rather than a science, further legitimated women’s presence in medicine. By 1900, approximately 5% of physicians were women. While this may seem like a small percentage, this figure actually exceeds the percentage of women who were in law and comparable professions at this time. Nineteenth century physicians did not necessarily understand their work as “scientific” in the contemporary sense, which allowed women an entrance.³

American medical education was notoriously lax during the nineteenth century. Colleges of medicine proliferated in the U.S., many of which were for-profit institutions. In such a marketplace it did not behoove medical colleges to enforce high standards for entrance — or, indeed, for completion of degree. Until the Civil War at least, many students earned medical degrees without ever performing a dissection or treating a patient firsthand. Not until the 1920s did American medical colleges even uniformly require a college degree for entrance. However, the disorganized state of medical education proved advantageous for women who aspired to become physicians.⁴ It wasn’t a commitment to freedom in the abstract, but rather the unregulated American medical marketplace that enabled early women physicians such as Elizabeth Blackwell — herself a British immigrant — to obtain medical education as early as 1849.

But even granting that women’s medical education was available earlier in the U.S. than elsewhere, by 1885, when the famous photograph was taken, many other countries also offered medical education for women. This includes not just European and North American countries such as Great Britain, Canada, and Germany, but also some countries in Asia. In 1883, the year that Joshee entered WMCP, Kadambini Basu was admitted to Calcutta Medical College. Although the Medical Council initially denied Basu’s application, the Lieutenant-Governor of Bengal overruled the decision.⁵ It is simply not the case that the U.S. was exceptional in providing medical education for women in the late nineteenth century. This raises a question: why did international students attend WMCP?

While the women’s stories vary a great deal, most of them came to the U.S. not because of a uniquely American dedication to freedom, but rather because of the presence of Americans in their home countries. Protestant missionaries were particularly significant. Even Joshee, who was Hindu and publicly criticized missionaries’ religious intolerance, had missionary connections. In 1878, when Joshee was only thirteen years old, her husband Gopalrao Joshee contacted an American missionary in Kolhapur to discuss the possibility of his young wife traveling to the U.S. for medical education. Characteristically, however, the male missionary he spoke to, J.M. Goheen, was more concerned with converting the Joshees than with their request. The Missionary Review, a Presbyterian missionary publication, reprinted Gopalrao’s letter alongside a response from Reverend Wilder, a leader in the Presbyterian missionary movement. Wilder encouraged the Joshees to remain in India, where Anandibai could learn from American missionaries and serve as a shining example of Protestant wifehood.

Wilder’s response was less than helpful. But it would nevertheless lead to Joshee traveling to the U.S. to become a physician. A white American woman from Roselle New Jersey, Theodocia Carpenter, read the letter, allegedly while waiting in her dentist’s office. Carpenter’s ideas about women’s capabilities differed from the more orthodox male missionaries, and so she contacted Anandibai and Gopalrao independently. This began a lively correspondence between Anandibai and Carpenter that developed over the course of years. By the time Joshee left India in 1883, unaccompanied by Gopalrao, the two women affectionately referred to each other as “aunt” and “niece.” Joshee’s relationship with Carpenter facilitated her ability to travel to the U.S. She also made the sea voyage alongside American missionaries. Missionaries hence enabled Joshee’s sojourn, if unwittingly.

Joshee’s story is actually rather anomalous among WMCP’s international students. All other Asian women who studied at WMCP around the turn of the twentieth century were Christian, most of them Protestants with strong missionary connections. Chinese graduates Hu King Eng and Li Bi Cu, for example, received sponsorship from the Woman’s Medical College of the Methodist Episcopal Church. Another Protestant Chinese woman, Tsao Liyuin, received financial support from a pair of sisters in St. Louis, one of whom was herself a physician. Gurubai Karmarkar, an Indian woman who graduated from WMCP in 1892, came to the U.S. in the company of her husband Sumantrao, who became an ordained reverend of the Congregationalist Church while Gurubai studied medicine. All of these women were involved in missionary work before coming to the U.S. They later returned to their home countries and practiced medicine as missionary physicians, under the auspices of missionary organizations first established in the U.S.

The Protestant missionary movement, more than any other factor, enabled this group of women to receive medical education in the U.S. There were some exceptions, however, including Filipina physicians Honoria Acosta-Sison and Olivia Salamanca. Their sponsors were not missionaries, but the U.S. state itself. Acosta-Sison and Salamanca were the first two Filipina women to become physicians. Both were recipients of scholarships from the pensionados program. From its inception, the pensionados program was designed to help propagate American colonial rule in the Philippines amidst military resistance from many Filipinos even after the Philippine-American war’s supposed end. Colonial officials hoped that by funding scholarships for a select few, they would cultivate a professional elite friendly to U.S. rule.⁶

Out of the first class of ten pensionados recipients, Acosta-Sison and Salamanca were the only women. That both women entered WMCP indicates how the College had developed a reputation as an institution that trained women physicians internationally. In many ways, the women became exemplars of the pensionados program, as both were relatively friendly to U.S. colonial rule, which they considered to be preferable to the Spanish colonialism that preceded it. Salamanca, writing in 1910 in The Esculapian, a publication produced by WMCP students, stated plainly:

[gblockquote source=’– The Esculapian, Vol. 1, No. 4.’]The roar of Dewey’s guns was the signal of the dawn of the great awakening of the Philippines. It not only delivered us from oppression, increased our political and religious rights, furnished us with the great opportunity, so long denied to us, to develop our latent intellectual powers, but also stimulated the Filipino woman to achieve more and more and to place herself gradually on the same intellectual footing with men.[/gblockquote]

For Salamanca, the advent of American imperialism in her home country represented freedom. This position undoubtedly appears peculiar and even paradoxical to contemporary observers.

But Salamanca actually understood something that many contemporary presentations of WMCP’s international history omit. Opportunities afforded to international students were made possible by U.S. imperial power overseas. Sometimes it was well-meaning missionaries who were agents of U.S. imperial power. At other times, it was General George Dewey and his army of soldiers. The international students’ presence in the U.S. around the turn of the twentieth century are hardly simple signifiers of American freedom. Their transnational careers would be more accurately understood as an unintended consequence of U.S. imperial expansion.

Salamanca, Acosta-Sison, and their fellow international graduates did play a part in U.S. history and the history of medicine that has been previously unrecognized. In many ways, these histories are triumphant stories of women’s accomplishments in the face of barriers and hostility. But these histories also cannot be disentangled from the equally long history of U.S. imperial power and colonial conquest.

Notes

1. The College graduated from 30-50 women per year during this period, meaning that women from Asia and Latin America constituted a fairly small proportion of WMCP’s graduates. As compared to the number of women who earned MDs in the U.S. as a whole, their numbers were even smaller. According to historian Regina Morantz-Sanchez, in 1890, there were 648 women medical students enrolled in the U.S. This reached a high of 1,063 in 1899 before declining afterwards. (See Morantz-Sanchez, Sympathy and Science, 249.) The majority of WMCP students at this time were white women born in the U.S. But the College also had a history of graduating some Black women as physicians, beginning with Rebecca Cole, who graduated in 1867. Additionally, during the period from 1880 to 1920, the College graduated a number of women born in eastern Europe, most of whom were Jewish women who remained in the U.S. after graduation. The first American Indian woman to earn an MD, Omaha physician Susan La Flesche Picotte, graduated WMCP in 1889. While a full social history of WMCP is well beyond the scope of my research, it would be accurate to say that the College was a majority white institution with a relatively high degree of racial and national diversity as compared to other medical colleges of the time. The College took pride in educating students of many nations, although its presentation of race appears rather dubious from a contemporary perspective. Articles such as “Women of All Nations Strive to Become Physicians” are common among college records. Return to text.
2. Thomas Neville Bonner, To the Ends of the Earth: Women’s Search for Education in Medicine (Cambridge: Harvard University Press, 1992), 14-16. Return to text.
3. Regina Morantz-Sanchez, Sympathy and Science: Women Physicians in American Medicine (Chapel Hill: University of North Carolina Press, 2000 [1985]), especially p. 244. Return to text.
4. For a comparative study of medical education in the U.S. to that of major European powers (Great Britain, France, and Germany), see Bonner, Becoming a Physician: Medical Education in Great Britain, France, Germany, and the United States, 1750-1945 (Oxford: Oxford University Press, 1995). Even the British system of medical education, which was less standardized and rigorous than its Continental counterparts, was more regulated than the American system, which was often left in the hands of fractious state medical societies rather than the law. Return to text.
5. Geraldine Forbes, Women in Colonial India: Essays on Politics, Medicine, and Historiography (New Delhi: Chronicle Books, 2008 [2005]), p. 111. Return to text.
6. Paul A. Kramer, “Is the World Our Campus? International Students and U.S. Global Power in the Long Twentieth Century [PDF],” Bernath Lecture, Diplomatic History, Vol. 33, No. 5 (November 2009). Return to text.

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Featured image caption: Photograph of medical students Anandibai Joshee, Keiko Okami, and Sabat Islambooly. Islambooly’s first name is misspelled, as is Serampore. 1885. (Woman’s Medical College of Pennsylvania, Photograph Collection. Courtesy of Drexel University, College of Medicine, Archives & Special Collections.)