Becoming a Gynecologist
Dickinson grew up among those who were reaping the benefits of the industrial expansion of the United States in the late nineteenth century. Born into an affluent home in Brooklyn Heights in 1861, Dickinson was brought up with traditional, New England Episcopalian values. Civic responsibility, professionalism, and the sanctity of the family were some of his foremost concerns.22 Industrial expansion and its accompanying population growth in the cities caused concern for men like Dickinson. The decline in Protestantism and the growth of Catholic and Jewish populations in the city were particularly problematic for many in his social milieu. There was much concern among protestants that this change in the distribution of population would lead to a decline in morality to the detriment of the American social order. These changes lead many Protestant churches to become involved in urban reform.23
It was a bright and prosperous time for Dickinson's family. His father was an industrialist and was well able to provide for Dickinson's education and travel. Dickinson was an accomplished swimmer, sailor, and artist. He was exposed to the polite upper-class society of Brooklyn Heights and summered at his uncle's farm in Connecticut. It was at this farm that he suffered a terrible accident which left him with a large, permanent scar because of inadequate medical attention. A carpenter had to sow his stitches because no doctor could be found. Through this experience, Dickinson recalled discovering his passion for medicine. He wanted to alleviate suffering because he himself had not received adequate medical care. 24
When he and his family returned to America from a four year sabbatical in Europe in 1877, Dickinson entered Brooklyn Polytechnic Institute. There he received a traditional liberal arts education which was equivalent to the last years of high school. After graduation he entered the Long Island College Hospital medical school instead of accepting a job in lithography. Before the sweeping changes brought about three decades later by the Flexner Report, medical schools did not require a college degree for admission. This school was a symbol of the new found prosperity of Brooklyn. Long Island College Hospital medical school modeled itself on the European university-hospital system; it was the first teaching hospital in the United States.25
Dickinson exhibited a passion for gynecology early on in his education. Dr. Alexander J. C. Skene (1837-1900) served as his mentor. Skene was a prominent Brooklyn gynecologist who won his reputation by his successful and sometimes inventive practice, but not by his research. Dickinson worked closely with him and served as an illustrator on his Treatise on Diseases of Women (1888).26 Dickinson drew upon his artistic skill often in his life and employed it to his advantage in his gynecological practice. He went on to graduate first in his class at Long Island College Hospital. He was unable to immediately get involved in research because the necessary grant possibilities did not yet exist in the American medical establishment. Like many other new medical graduates of his generation, Dickinson went into private practice. The many patients he saw in his successful practice would later serve as case material for his inquiries into the nature of sex.27
The state of American medicine was quite different when Dickinson became a gynecologist than when he began to focus exclusively on sex research in the 1920s. In the 1870s and 1880s the state licensing of medical practitioners was beginning in earnest. Doctors in many areas had to register with state medical boards in order to obtain licenses to practice. New physicians generally had to have diplomas from medical schools, although existing practitioners could still continue their careers without a degree. Although medical schools were not regulated in any particular fashion, these boards could reject applications from doctors who had diplomas from disreputable schools.28 Dickinson received his license to practice through his diploma. However, Long Island College Hospital would later be regarded as a second-rate institution. Nonetheless, Dickinson's medical education was better than average for his day.
The lax nature of medical regulation equated to wide ranging standards for becoming a medical practitioner. There was no strict control over what was taught in schools and no strong emphasis on research. The focus of medical training was on practice, not the advancement of medical knowledge. Medical schools did not have substantial endowments or state funding. Many schools were privately run for profit. This lack of funding left little money for research but this would soon change.29 Dickinson would become caught up in the movement for the reform of medicine through a new emphasis on scientific objectivity. Medicine's new focus on scientific research was in part ushered in by the Flexner report of 1910.
American medicine experienced a significant change in the early part of the twentieth century. Doctors began to slowly organize under a national body. To facilitate this, the American Medical Association was established in 1846. It was not until the twentieth century that its membership grew significantly. From 1900 to 1910, the AMA's membership increased from eight thousand to seventy thousand. According to Paul Starr, many physicians felt that their economic and professional rights were not being represented. They wanted to have a greater voice in American society through collective action. Following the organization of labor and corporatization of capital that was a hallmark of the Gilded Age, physicians wanted to organize to improve their standards of living. Doctors sought to escape from corporate exploitation through socioeconomic solidarity. Doctors in the period succeeded in improving their economic status and their social respectability.30
The American Medical Association was not just interested in the consolidation of professional authority. Reform of the medical college establishment was crucial to forming a strong, independent profession. In 1904, the AMA established a Council on Medical Education that was mandated to improve and standardize requirements to get into medical school. It also investigated the quality of medical schools. The council soon realized the situation was grave; many schools were far below the standards they sought to establish. The AMA chose not to publish these findings for fear they would violate codes of professional solidarity. However, they called upon the Carnegie Foundation for the Advancement of Teaching to do an independent survey which culminated in the publication of the Flexner Report in 1910.31
The Flexner report demonstrated the discrepancy between the progress that had been made in medical science and the backward state of medical education. The smaller schools were the hardest hit by the report. Many of them claimed to be research oriented but the Flexner report contradicted their claims. A large number of smaller medical schools which were run for profit, could not afford to invest in expanded research facilities. The impact of the report caused the closure of these schools because they could no longer produce certifiable graduates. The consolidation of medical schools was accompanied by a reduction in graduates and a standardization of medical education.32
However, the consolidation of medical schools brought about by the changing structure of the American medical establishment had a negative impact on women, minorities, and those who could not afford to pay the rising cost of a medical education. Only those with the necessarily large financial resources could pay for medical school and the new preparatory education necessary for acceptance into a medical school. Many schools, which had previously accepted women and minorities, could not afford to make the necessary changes to become more scientifically credible. Policies were adopted that discriminated against Jews, women, and African-Americans in many of the surviving schools. As a result, medicine became an increasingly elite upper class, white male dominated profession.33
Many philanthropic foundations began donating heavily to the remaining medical institutions which followed a program of research-oriented, academic medicine exemplified by the Johns Hopkins University. The AMA's support of medical education reform combined with the flow of capital to these institutions made them dominate the profession. By the 1920s, this shift in the American medical establishment focused resources on the basic science aspects of medicine such as physiology, cell biology, and anatomy. Expanded research facilities and full-time clinical research positions existed at nearly all medical schools. Patient care was no longer the primary focus of a medical education. Young doctors were trained to be both scientists and care givers. Scientific research received a new prestige which had not been seen before in American medicine which transformed the climate in which physicians practiced.34
The impact of the changes in medicine led to increased professional authority. The rise of income and status of physicians in this period was linked not only to medicine's reorganization but to the widespread cultural acceptance of this privileged role of the doctor. Paul Starr sees these changes as resulting from the, "widespread support, which they received because of complex changes overtaking the entire society, physicians were able to see social interests defined so as to conform with their own. This was the essence of their achievement."35 The medical establishment positioned itself to have a near monopoly on matters of health in America.
It was a bright and prosperous time for Dickinson's family. His father was an industrialist and was well able to provide for Dickinson's education and travel. Dickinson was an accomplished swimmer, sailor, and artist. He was exposed to the polite upper-class society of Brooklyn Heights and summered at his uncle's farm in Connecticut. It was at this farm that he suffered a terrible accident which left him with a large, permanent scar because of inadequate medical attention. A carpenter had to sow his stitches because no doctor could be found. Through this experience, Dickinson recalled discovering his passion for medicine. He wanted to alleviate suffering because he himself had not received adequate medical care. 24
When he and his family returned to America from a four year sabbatical in Europe in 1877, Dickinson entered Brooklyn Polytechnic Institute. There he received a traditional liberal arts education which was equivalent to the last years of high school. After graduation he entered the Long Island College Hospital medical school instead of accepting a job in lithography. Before the sweeping changes brought about three decades later by the Flexner Report, medical schools did not require a college degree for admission. This school was a symbol of the new found prosperity of Brooklyn. Long Island College Hospital medical school modeled itself on the European university-hospital system; it was the first teaching hospital in the United States.25
Dickinson exhibited a passion for gynecology early on in his education. Dr. Alexander J. C. Skene (1837-1900) served as his mentor. Skene was a prominent Brooklyn gynecologist who won his reputation by his successful and sometimes inventive practice, but not by his research. Dickinson worked closely with him and served as an illustrator on his Treatise on Diseases of Women (1888).26 Dickinson drew upon his artistic skill often in his life and employed it to his advantage in his gynecological practice. He went on to graduate first in his class at Long Island College Hospital. He was unable to immediately get involved in research because the necessary grant possibilities did not yet exist in the American medical establishment. Like many other new medical graduates of his generation, Dickinson went into private practice. The many patients he saw in his successful practice would later serve as case material for his inquiries into the nature of sex.27
The state of American medicine was quite different when Dickinson became a gynecologist than when he began to focus exclusively on sex research in the 1920s. In the 1870s and 1880s the state licensing of medical practitioners was beginning in earnest. Doctors in many areas had to register with state medical boards in order to obtain licenses to practice. New physicians generally had to have diplomas from medical schools, although existing practitioners could still continue their careers without a degree. Although medical schools were not regulated in any particular fashion, these boards could reject applications from doctors who had diplomas from disreputable schools.28 Dickinson received his license to practice through his diploma. However, Long Island College Hospital would later be regarded as a second-rate institution. Nonetheless, Dickinson's medical education was better than average for his day.
The lax nature of medical regulation equated to wide ranging standards for becoming a medical practitioner. There was no strict control over what was taught in schools and no strong emphasis on research. The focus of medical training was on practice, not the advancement of medical knowledge. Medical schools did not have substantial endowments or state funding. Many schools were privately run for profit. This lack of funding left little money for research but this would soon change.29 Dickinson would become caught up in the movement for the reform of medicine through a new emphasis on scientific objectivity. Medicine's new focus on scientific research was in part ushered in by the Flexner report of 1910.
American medicine experienced a significant change in the early part of the twentieth century. Doctors began to slowly organize under a national body. To facilitate this, the American Medical Association was established in 1846. It was not until the twentieth century that its membership grew significantly. From 1900 to 1910, the AMA's membership increased from eight thousand to seventy thousand. According to Paul Starr, many physicians felt that their economic and professional rights were not being represented. They wanted to have a greater voice in American society through collective action. Following the organization of labor and corporatization of capital that was a hallmark of the Gilded Age, physicians wanted to organize to improve their standards of living. Doctors sought to escape from corporate exploitation through socioeconomic solidarity. Doctors in the period succeeded in improving their economic status and their social respectability.30
The American Medical Association was not just interested in the consolidation of professional authority. Reform of the medical college establishment was crucial to forming a strong, independent profession. In 1904, the AMA established a Council on Medical Education that was mandated to improve and standardize requirements to get into medical school. It also investigated the quality of medical schools. The council soon realized the situation was grave; many schools were far below the standards they sought to establish. The AMA chose not to publish these findings for fear they would violate codes of professional solidarity. However, they called upon the Carnegie Foundation for the Advancement of Teaching to do an independent survey which culminated in the publication of the Flexner Report in 1910.31
The Flexner report demonstrated the discrepancy between the progress that had been made in medical science and the backward state of medical education. The smaller schools were the hardest hit by the report. Many of them claimed to be research oriented but the Flexner report contradicted their claims. A large number of smaller medical schools which were run for profit, could not afford to invest in expanded research facilities. The impact of the report caused the closure of these schools because they could no longer produce certifiable graduates. The consolidation of medical schools was accompanied by a reduction in graduates and a standardization of medical education.32
However, the consolidation of medical schools brought about by the changing structure of the American medical establishment had a negative impact on women, minorities, and those who could not afford to pay the rising cost of a medical education. Only those with the necessarily large financial resources could pay for medical school and the new preparatory education necessary for acceptance into a medical school. Many schools, which had previously accepted women and minorities, could not afford to make the necessary changes to become more scientifically credible. Policies were adopted that discriminated against Jews, women, and African-Americans in many of the surviving schools. As a result, medicine became an increasingly elite upper class, white male dominated profession.33
Many philanthropic foundations began donating heavily to the remaining medical institutions which followed a program of research-oriented, academic medicine exemplified by the Johns Hopkins University. The AMA's support of medical education reform combined with the flow of capital to these institutions made them dominate the profession. By the 1920s, this shift in the American medical establishment focused resources on the basic science aspects of medicine such as physiology, cell biology, and anatomy. Expanded research facilities and full-time clinical research positions existed at nearly all medical schools. Patient care was no longer the primary focus of a medical education. Young doctors were trained to be both scientists and care givers. Scientific research received a new prestige which had not been seen before in American medicine which transformed the climate in which physicians practiced.34
The impact of the changes in medicine led to increased professional authority. The rise of income and status of physicians in this period was linked not only to medicine's reorganization but to the widespread cultural acceptance of this privileged role of the doctor. Paul Starr sees these changes as resulting from the, "widespread support, which they received because of complex changes overtaking the entire society, physicians were able to see social interests defined so as to conform with their own. This was the essence of their achievement."35 The medical establishment positioned itself to have a near monopoly on matters of health in America.
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