A key to improving the medical profession’s status lies in the development of professional associations. Although women physicians in the United States professionalized early on, American midwives did not. Cultural ideas about gendered knowledge prevented midwives from becoming professional; midwives could only be women and, therefore, according to male
461 Henry S. Houghton, letter to E.C. Lobenstein, October 11, 1937, folder 669, box 94, RG IV2B9, RAC. 462 Ibid.
physicians, could not grasp the scientific childbirth methods that physicians could. According to Charlotte Borst, the reason physicians displaced midwifery in the United States is that the latter failed to professionalize, especially by establishing educational institutions.464 Magali Sarfatti Larson, in a study of the growth of professionalism, states that
“education plays a key role in the institutionalization and legitimation of a profession. Historically, instruction for many occupations has evolved from the relative informality of apprenticeships to formal training based on the
standardization and codification of knowledge. …Once established, this school- based education has then been the main support of a professional subculture. In addition, … professional development has also needed to claim an exclusive body of knowledge. To then achieve a monopoly over practice, the profession needs to control both the ‘production of knowledge and the production of producers.’”465
The apprentice-trained midwives in the United States did not qualify for such
professionalization. They did not control the means of education, and they did not form strong professional organizations. By the 1920s and 1930s, physicians were already beginning to displace midwives in the birthing room, and women had long been excluded from the male- dominated professional organizations. More recounts that “as late as 1929, according to the well-known Chicago obstetrician-gynecologist Bertha Van Hoosen, women ‘were not regarded as eligible for membership’ in the national obstetrical and gynecological societies.”466 The American Gynecological Society, which was created in 1876, did not elect its first female member (Dr. Lillian K.P. Farrar) until 1921. The second was elected in 1971. Three more were elected in 1980. The official history of these two organizations, published in 1985, maintains that “the Society’s slowness in incorporation of women into membership should change in the
464 Borst, Catching Babies.
465 Larson, The Rise of Professionalism. 466 More, Restoring the Balance, 49.
future, since one-third of present medical students are women and 50 percent of residents training in obstetrics and gynecology are women.”467 Women in the United States as midwives and even as physicians were excluded from being fully accepted into their professions.
In China, the professional medical associations attempted to monopolize their power by drawing distinctions between educated medical personnel and uneducated quacks through licensing and membership restrictions. Governments backed these organizations because of the importance of public health and sanitation, especially during periods of epidemics. Chinese professional associations were sanctioned by and worked closely with the Republican government in legislating licensing and membership restrictions, and in public health and sanitation efforts.468 Furthermore, midwifery and nursing associations created forums for discussing and organizing around political and social issues, published journals that promoted their profession, and established and oversaw educational programs. The discussion of Chinese organizations can be supplemented with data from the national Chinese Medical Association and the Nurses’ Association of China, both founded by Westerners but later taken over by Chinese physicians and nurses. These national groups served as models for the local ones, and by their association helped to improve the standing of midwifery and nursing.
Many graduates of PUMC became leaders of the Chinese Medical Association. This group was a merger of the Western-run China Medical Association, originally formed in 1886 as the Chinese Medical Missionary Association, and the Chinese-led National Medical Association of China. In 1932, these two organizations joined to form the Chinese Medical Association. By this time, most of its leaders and members were Chinese, either medical scientists or public health physicians, many trained at PUMC. Its membership grew to 1,700 members by 1935. In
467 Taylor, History of the American Gynecological Society, 28.
1928, Robert S.K. Lim was elected president, and the Association’s emphasis began to transition from social to scientific issues. The leaders were very public minded, and the association began to influence the national health administration and its policies. They formed a committee on public health that was active in prevention of tuberculosis, venereal disease, and cholera, and in promoting maternal and child health. They also supported the central Ministry of Health in implementing health measures and creating criteria to evaluate municipal health administrations.
The Chinese Midwifery Association was established in the spring of 1933 by FNMS graduates with the goals of “undertaking research into the science and art of midwifery, the cultivation of friendship among our fellow workers, and the promotion and development of midwifery education.”469 It was headquartered at the First National Midwifery School in Beiping. Membership included all midwives who had passed examination, either in China or abroad, and had been recommended by two or more members of the Association. Membership came in three different classes: 1.) Regular Members, who paid regular membership fees of $6 per year, were eligible to make recommendations and attend meetings; 2.) Permanent Members, who had paid a lifetime membership fee of $60, helped to promote interests of the Association, give advice, and “strengthen the foundation of the Association;”470 and 3.) Honorary Members, who were advisors to the Association and included some non-midwives. Its advisors were Drs. Marion Yang and Yang Baozhun. According to an FNMS annual report, the Association
published a quarterly journal beginning in June 1933. Unfortunately, there was no other mention of this organization in any FNMS report issued after 1933, and I have been unable to locate any other information on the Association.
469 “Fifth Annual Report, FNMS,” Appendix III: Outline of Organization of the Chinese Midwifery Association,
viii.