For all that the prevailing view of 19th century men was that women were "the weaker sex", not every woman was willing to agree. Despite the formidable barriers placed in their path, women managed to force their way into the most unexpected places. And that included any kind of medical training for women. Given that such training would involve exposing women students to material deemed inappropriate for their gender, most medical schools automatically rejected any women applicants.

By the mid-1850s however, things began to change. Along with the example of Florence Nightingale and her fellow nurses tending wounded soldiers during the Crimean war, Elizabeth Blackwell made medical history by being the first woman to graduate from a medical school in 1849 and the first to be placed on the United Kingdom Medical Register in 1859. Along with her sister Emily, Blackwell helped mentor a new generation of women medical students, as well as promoting the cause of medical education for women in general.

Not surprisingly, there was still considerable opposition. One of the most outspoken of the doctors opposing medical education for women was Edward H. Clarke of Harvard University. And, of course, being a doctor, his arguments focused on the medical reasons for why women shouldn't become doctors. In his 1873 book, Sex and Education, Clarke emphasized that women had the right to do anything of which they were physically capable. But it was the phrase "physically capable" that was the sticking point for him.

As Clarke pointed out, the development of the female reproductive system placed strains on the body which prevented them from the kind of intellectual development seen in boys going through puberty. Since the nervous system couldn't do "two things well at the same time," females needed to concentrate primarily on their physical development to ensure their health. Though Clarke was careful in how he worded his views, the implication seems clear enough: Women who receive the kind of higher education that men do risk developing various health problems including "neuralgia, uterine disease, hysteria, and other derangements of the nervous system" because their overactive brains were using up the physical resources needed for proper development of their reproductive systems.

Even more importantly from Clarke's perspective, women who devoted too much time to intellectual pursuits also experienced mental changes. This included losing their maternal instincts and "an an appearance of Amazonian coarseness and force." He added that such women "are analogous to the sexless class of termites. Naturalists tell us that these insects are divided into males and females, and a third class called workers and soldiers, who have no reproductive apparatus, and who, in their structure and instincts, are unlike the fertile individuals."

That wasn't to say that Clarke objected to all higher education for women. He stressed that men and women needed to be educated separately and that different educational methods be used to avoid the medical problems associated with overstraining the female reproductive system. Female-only classes would include periodic rest times keyed to their menstrual periods to avoid conflict. They would also need shorter study hours due to their inability to handle the kind of academic pressure that men could. As he pointed out:

A girl cannot spend more than four, or, in occasional instances, five hours of force daily upon her studies, and leave sufficient margin for the general physical growth that she must make.... If she puts as much force into her brain education as a boy, the brain or the special apparatus [i.e., the reproductive system] will suffer.

Given his own status as a Harvard professor, he concluded that women be prevented from attending Harvard Medical School or any other academic institution where they might be forced to compete with men intellectually given that such pressure would endanger their potential status as wives and mothers. For that matter, forcing men to compete with women in this way would diminish both genders since, as he phrased it, "To make boys half-girls, and girls half-boys, can never be the legitimate function of any college." Not that Clarke was the only medical pundit to argue that women were too unstable and frail to be educated alongside men. In his 1900 address to the American Gynecological Society, George Julius Englemann urged that schools for girls needed to deal with the "instability and susceptibility of the girl during the functional [menstrual] waves which permeate her entire being" by providing rest during the menstrual periods.

Given fears that menstruation made all women unstable, even educational institutions that had begun admitting women raised concerns about damaging the health of their women students. An 1877 statement by the Board of Regents at the University of Wisconsin suggested that "it is better that the future matrons of the state should be without a University training than that it should be produced at the fearful expense of ruined health; better that the future mothers of the state should be robust, hearty, healthy women, than that, by over study, they entail upon their descendants the germs of disease." In other words, women students risked damaging their own health and the health of the future children by too much study.

Well into the 20th century, the co-education of men and women remained a controversial topic and most schools pushed for a sexually segregated curriculum that taught "appropriate" subjects for boys and girls. This included courses such as Home Economics which were meant to direct women towards their future roles as wives and mothers. Separate colleges for men and women were also founded including Radcliffe College in Massachusetts and Vassar College in New York and quickly developed reputations for academic excellence. Still, their graduates often found themselves at a disadvantage in male-dominated industries such as medicine. Not surprisingly, the impact that Edward Clarke's book had on the debate over women's education frankly alarmed women's rights advocates on both sides of the Atlantic. Being a Harvard professor and a medical doctor gave Clarke's arguments instant credibility and the only effective way to counter them was to find hard scientific evidence that women were far less fragile than he claimed.

Which brings us to Mary Putnam (later Jacobi) Born in London in 1842, she grew up in New York where she privately studied medicine with Elizabeth Blackwell. As the daughter of George Putnam, one of the giants of American publishing, she had an early introduction to the American literary community. Her father objected to his daughter's choice to become a medical doctor but he ultimately came around. After serving in the U.S. Civil War as a medical aide, she eventually earned her medical degree from the Woman's Medical College in Pennsylvania. She then went to France and became the first woman to enter the Ecole de Medicine in Paris where she earned her second medical degree in 1871.

In an unpublished autobiography written during the final years of her life, Jacobi explained that her determination to become a medical doctor began in her early childhood. After finding a dead rat near her family home, she recalled thinking "“If I had the courage I could cut that rat open and find his heart which I greatly longed to see.” While her mother put a stop to this early experiment in comparative anatomy, she remained determined to learn more about science as a way to protect herself from the overly-enthusiastic religious education provided by her evangelical grandmother. She also had trouble accepting the second-class status of women in general, especially since they were routinely shut out of higher education in most universities. Her own uphill battle to be accepted as a medical doctor was proof of that.

On returning to the United States in 1871, she went on to become probably the most important woman physician of her era. After marrying physician Abraham Jacobi in 1873 and changing her own name, she quickly established a reputation as a serious medical researcher with publications in all of the leading medical journals. She also became a professor at the Women's Medical College of the New York Infirmary and also taught at the New York Post-Graduate Medical School. Along with helping establish the Pediatric Clinic at Mount Sinai Hospital, she worked at the New York Infirmary for Women and Children and was a visiting physician at St. Mark's Hospital.

But Jacobi and other women physicians still had to struggle to gain popular acceptance. Not only was it considered "unseemly" for women to have intimate knowledge of the human body, but many male physicians argued that women doctors weakened the profession due to their frail dispositions. This is what made Edward Clarke's controversial book so damaging and the prospect of women becoming "unsexed" by medical training seemed like a compelling argument.

At the same time, there was also a fierce debate over the very nature of medicine and the role of science. While scientist-practitioners like Jacobi stressed the importance of medical research in shaping how physicians treated their patients, many doctors preferred to rely on a more intuitive approach. That often caused conflicts for the male doctors treating women patients due to various misconceptions about female anatomy and how it affected patients psychologically. It was during this era that "hysteria" became an overused diagnosis for a wide variety of psychological problems that women might experience in their lives To treat this "condition", doctors often prescribed a bewildering variety of supposedly effective remedies, including the surgical removal of their ovaries - an operation that led to the deaths of countless women patients.

Mary Putnam Jacobi spent her life countering this male-dominated perspective on women' health. More importantly, she recognized the medical problems that women and children faced at a very personal level. Jacobi and her husband had three children of whom only one survived infancy. The pain of these losses caused them to dedicate themselves to improving child health through proper nutrition and prevention of infectious diseases. Through the 1870s and 1880s, Mary Jacobi also dedicated herself to women's health issues.

It was during this period when she wrote her famous rebuttal to Edward Clarke's book, The Question of Rest For Women During Menstruation. Published in 1876, her book won Harvard University's Boylston Prize and became an early classic in gynecology. Challenging all of Clarke's arguments, Jacobi's book included her own extensive research on woman patients including statistics and medical data outlining changes in female health, strength, and emotion throughout the menstrual cycle. Her hard evidence emphatically demonstrated that Clarke's ideas about frail women were completely false though many of her male colleagues tended to "cherry-pick" details out of her work to support their own ideas.

In many ways, Mary Putnam Jacobi was full of apparent contradictions. An early opponent of women's suffrage, she argued instead that health and education were more important than being able to vote (she later changed her mind though). She also clashed publicly and often with her fellow women's rights advocates, including Elizabeth Blackwell, over the direction their movement should take in ensuring greater sexual equality. Though Blackwell argued that women should use their female values to provide the kind of medical care that male doctors couldn't, Jacobi maintained that men and women needed to be equal in the medical care they provided patients. While many younger women doctors openly admired her powerful presence whenever she entered the room, as well as her formidable intelligence, her temper and inability to bear fools gladly "did not always add to her popularity" as Emily Blackwell once said.

She was also an avid workaholic, only taking time off from medicine on Sunday afternoons. Along with her grueling medical practice, she was also an dedicated researcher. Even after being diagnosed with a fatal brain tumour, she spent her last months carefully documenting the progress of her disease which she published as "Descriptions of the Early Symptoms of the Meningeal Tumor Compressing the Cerebellum." She died in June, 1906 survived by her husband and daughter.

Largely through the work of Mary Putnam Jacobi and other female doctors like her, more women than ever sought out medical careers. In the United States alone, there were 7000 woman doctors by 1900 representing five percent of all medical school graduates. Still, arguments from critics such as Edward Clarke continued to be raised and women continued to face barriers in gaining wider acceptance by male colleagues and society in general. Even today, women face challenges in many professions that continue to be male-dominated. Though the medical arguments have long since been refuted, the informal barriers can be as difficult as ever especially since women are expected to balance family life and professional work much more seamlessly than their male counterparts.

Mary Putnam Jacobi would understand that all too well.