Ann Preston: Pioneer of Medical Education and Women’s Rights

One of the earliest supporters of a woman’s tight to a medical education was Ann Preston. In the late 1840s, she was refused admission to the famous medical schools of Philadelphia because of her sex, yet she persevered in her efforts to obtain medical training, earned her M.D. degree and spent the rest of her life working for the improvement of women’s medical education and for the acceptance of women physicians as fully qualified professionals. She became the first woman dean of a medi­cal college, played a major role in the founding of the Woman’s Hospital of Philadelphia, established one of the earliest training courses for nurses, and pioneered in stress­ing the importance of compiling accurate statistics and teaching preventive medicine in medical practice. In the mid-nineteenth century. medicine was not generally con­sidered a suitable occupation for women, but by the 1880s, Ann Preston’s efforts had ensured the full acceptance of women as medical practitioners.

Born December 1, 1813, Ann was the first child of Amos and Margaret Preston, members of the Society of Friends. From her Quaker parents, she acquired a belief in the need for social action to alleviate the misfortunes of others; she also learned a calm assuredness in the added power of religious faith in working toward social reform. During childhood, she developed the independence and self­-reliance which were later to be such assets to her career and to the growth of the Female Medical College of Pennsyl­vania (renamed the Woman’s Medical College of Pa. in 1867 and. finally, The Medical College of Pa. in 1970).

Ann grew up on her father’s farm in West Grove, attend­ing the local school, playing freely in the fields surrounding her home and learning to ride the farm horses. She was one of a family of nine children, six boys and three girls, al­though neither of the other girls survived to maturity. During Ann’s childhood her mother’s health gradually deteriorated. As Ann grew older, she took on more and more of the household tasks and soon became aware of the unhealthy circumstances forced upon women of all ages through household confinement, constricting clothing and Jack of recreational opportunities. She saw that males, both within her own family and among friends and neigh­bors, obtained adequate exercise in fresh air and sunshine, and were generally free from the many debilitating ill­nesses that afflicted their sisters, wives and mothers. This recognition of the importance of environment and lifestyles in maintaining good health led to her life-long interest in what was then called hygiene but was in reality the be­ginnings of preventive medicine.

Another great formative influence was her exposure to the work of the Underground Railroad. Her father’s farm adjoined that of his brother, Mahlon Preston, a Quaker minister, and both men frequently helped fugitive slaves, using their homes as supplementary stations. When Ann was about seven years old, a fugitive named Jarvis Smith stayed on as a farm worker, living with his wife and children on Amos Preston’s farm. After about two years, slave hunters learned of their whereabouts and tried to seize the family. Although Mahlon Preston and other neighbors arrived in time to force the kidnappers to make their claims before a judge, the husband, wife and youngest child were ordered returned to their former master in Maryland. Several weeks later, however, they again managed to escape and quickly made their way back to Mahlon Preston’s farm, this time being resettled in an area where there was no risk of re­capture. Their eldest daughter, then twelve, continued to live at the farm until she disappeared, apparently having been seized by slave hunters while working in one of the outbuildings. She was never heard from again. Events such as these made a deep impression on Ann at an early age and contributed greatly to her determination to fight for human rights the rest of her life.

As she grew older, Ann began to take an active part in the anti-slavery movement. The nearby home of James N. Taylor was one of the branch stations of the Underground Railroad to which Amos Preston sent fugitives. A contemporary reported that some were taken there “in a dearborn in day-time by Ann Preston and Elizabeth Coates … well covered so as to attract no attention.” On one occasion Ann admitted a fugitive slave woman to the house when her parents were absent for several days attending a meet­ing. One morning, a neighbor arrived with the warning that slave hunters had searched his house and would soon be at the Prestons’. As the man hastened to warn other families, Ann quickly devised a means of escape:

She locked the woman into the closet, went to the pasture, caught a horse, harnessed him to the carriage, then hastily dressing the woman in her mother’s plain shawl and Quaker bonnet, carefully adding the two veils often worn by plain Friends when riding, she started with her in the direction from which the slave­-catchers were expected, with the ostensible purpose of attending meeting, it being Sunday morning.

Soon they met the slave hunters who, deceived by the Quaker disguise, rode on to continue their search. Ann then drove to a house which had already been searched and the woman eventually reached safety in Canada.

Ann also assisted with the administrative work of the abolitionist movement. One of the most active of the area’s abolitionists was Lindley Coates. Prior to the formation of the American Society, when William Lloyd Garrison was little known, Coates helped form the Clarkson Anti-Slavery Association, which advocated immediate emancipation. Ann Preston worked as secretary to this association and thus obtained a detailed knowledge of the problems caused by bounty hunters from the slave states and by local sup­porters of slavery. The latter were especially active around Strasburg in Lancaster County. A group of them once threw stones and rotten eggs into a carriage occupied by Coates and Charles C. Burleigh as they passed through the district on their way home from a lecture by Burleigh. On one occasion, some of the local pro-slavery faction set fire to Coates’s barn after he consulted a lawyer about action against slave kidnappers. Ann’s first-hand knowledge of these events and her own exposure to the antagonism of pro-slavery groups undoubtedly helped her endure the resistance and hostility she was to meet in her later struggle to overcome social prejudice toward women physicians.

Ann’s interest in medicine began early when she faced her mother’s chronic illness and the deaths of her two sisters. Also, there were many physicians among the Prestons’ friends and acquaintances, some of them employing women as assistants. At that time, women had few opportunities for higher education as the professions, other than teaching, were closed to them. This disadvantage was a frequent topic of conversation among Ann’s circle of friends, which in­cluded Lucretia Mott, one of the founders of the Women’s Rights Movement. Some of the women working as medical assistants would have preferred to train as physicians had that been possible, and many local male physicians sup­ported their growing desire for access to medical school education. Among these supporters were Dr. Bartholomew Fussell; his nephew, Dr. Edwin Fussell; and Dr. Joseph Longshore and his brother, Thomas.

When Ann Preston decided to pursue a career in medi­cine, she began by applying for admission to the medical colleges of Philadelphia, which at that time were renowned as medical centers. After being refused by four colleges, she enrolled as a student of Dr. Nathaniel R. Mosely, be­coming the fifth woman studying at his private clinic. It was then 1848, when practical clinical training under the supervision of a qualified physician was an accepted method of beginning medical education.

Among the male supporters of women’s efforts to obtain full medical training was a Philadelphia businessman and philanthropist, William Mullen. Knowing of the strong local interest and the difficulties faced by women attempt­ing to enroll in established colleges, he began to investigate the feasibility of a medical college for women. With the assistance of Dr. Joseph Longshore, he finally obtained a charter and made plans for opening the institution in two rooms of a building at 229 Arch Street, Philadelphia. Mullen himself leased the building and paid for its equip­ment, but the college was organized under a Board of Corporators whose aim was to provide training equal in quality to that available in the established medical schools. Graduation requirements were two years of study with a practicing physician, followed by two sessions of college lectures totaling four months. A faculty of six men gave lectures, with accompanying demonstrations in anatomy classes. Pharmacy was taught at a dispensary attached to the college, and lying-in facilities provided opportunities for obstetric training. Classes began at 10 A.M. and con­tinued until 6 P.M. on weekdays, 2 P.M. on Saturdays. Clinics were held on Wednesdays and Saturdays from 12 until 2 P.M. Such a course conformed to standard medical training practice at that time.

Preston was one of forty women who applied for admis­sion to the first course, eight to work toward the M.D. degree and thirty-two as auditors. Instruction began in October 1850, and all eight degree candidates were awarded their doctorates on December 30, 185 l. Ann’s friend, Lucretia Mott, sat on the platform during this first gradua­tion ceremony of the Female Medical College of Pennsyl­vania. The Women’s Rights Movement finally seemed to be having some impact, although many press reports of the event referred to the new graduates as “doctresses” and treated them as objects of ridicule.

Ann ignored such jibes; she had finally realized her am­bition of becoming a fully qualified physician. Yet she felt a strong need for further study, and therefore decided to spend another year at the college before starting a practice. Her professional life, however, was to remain closely tied to the college, for at the end of her post-graduate year she accepted the position of instructor in physiology; thus, in 1853 she became “the first woman to have a professorial chair in a medical school.” Thereafter her career included roles as physician, teacher, administrator and advocate for the acceptance of women as competent professionals en­titled to all rights and privileges accorded male physicians.

As a physician, she constantly stressed the importance of preventive medicine. In this, she was decades ahead of her time. Her introductory lecture to the class of 1855-56 emphasized the secondary role of drugs in the treatment of disease, stating, “pure air, proper diet, well regulated exer­cise, the right government of passions and emotions, come first in the catalogue of healing and preserving agencies, and ‘medicines’ … are always subsidiaries.” On another occa­sion, she criticized the contemporary fashion of tight, con­stricting clothing for women. A civilization in harmony with nature and with health, she said, “will foster pure, quiet, simple tastes, and will find its modes of beauty in form and drapery, not in the vulgar devices by which fashionable mantua-making distorts and burlesques human proportions, but in the grace and freedom of artistic Nature and the corresponding fitness of clothing.”

Dr. Preston’s recognition of the rapid pace of medical progress and the consequent importance of life-time study for the physician was another indication of her far-sighted­ness. In the Valedictory Address of 1858, she reminded the graduates of the importance not only of subscribing to medical journals, but also of reserving time to read them. She also urged the new doctors to keep careful and accurate records, stating, “statistics are the best commentaries on theories.” Diagnosis, which had been the subject of Preston’s graduation thesis, remained one of her specialties, and in this same address of 1858, she warned the graduating stu­dents never to hesitate to consult a colleague on any case presenting a diagnostic problem. Such careful considera­tion, she said, is owed to the patient. “Besides,” she added, “the world throws no pitying screen over the mistakes of a woman.”

In her role as teacher, Ann Preston found herself severe­ly limited by the lack of clinical teaching facilities. All Philadelphia’s famous hospitals were closed to her students; even after obtaining the M.D. degree, women were allowed into the wards and clinics only as nurses. Consequently, students of the Female Medical College were restricted to the practical experience obtained at twice-weekly clinics held in the dispensary and at the college’s small obstetrical unit.

While still a student, Dr. Preston had recognized the need for adequate clinical facilities if the college was to survive and to develop into a first-class institution. There­fore, after becoming a member of the faculty she made plans to establish a hospital for women and children, run and staffed by women, with its medical staff also members of the college faculty. By 1858, she had organized a Board of Lady Managers to run the proposed hospital and had begun to raise money. She spoke at meetings, canvassed from house to house in the city and drove a horse and buggy around the suburbs, noting in her journal: “I went to everyone whom I thought would give us money or in­fluence.”

Her efforts were successful, and in September 1861 the hospital opened in a rented house on North College Ave­nue, then the outskirts of the city. College classes had ceased temporarily at the outset of the Civil War, but in October 1862, lectures were resumed in the new building. Following Professor Preston’s recommendation, several degree candidates lived in the hospital to gain experience in handling emergencies. Another of Dr. Preston’s innova­tions was the establishment of a training course for nurses; begun in 1863 and incorporating many of the practices advocated by Florence Nightingale, this was certainly one of the earliest such courses in the world.

In 1866, Dr. Preston was appointed dean of the college, thus becoming the first woman to hold such a position in a medical school. Still dissatisfied with the clinical facilities available to her students, she began her struggle to gain admission of women to the clinics of the larger hospitals. First, she obtained permission for them to attend the gen­eral clinics conducted by Dr. Alfred Stille in the amphi­theatre of Blockley Hospital. Dr. Stille gave the women a warm welcome and all went well. Dean Preston then arranged for her students to attend the general surgery clinics held each Saturday at the Pennsylvania Hospital. There the women met with a different reception and were forced to leave after being pelted with mud balls and other missiles by a crowd of rowdy male students. One witness later recalled having seen “Dr. Ann Preston, the first Dean, leading a small group of women medical students in a forced march down the middle of Chestnut Street pro­tected by the police from a mob of malevolent male students who had hooted them out of a clinic which the women had been given permission to attend.” Preston’s reaction to such intolerance was always a refusal to argue uselessly and a strengthening of her determination to prove the opposition wrong.

Like her friend Lucretia Mott, Ann Preston was an ardent supporter of the rights of women to full participa­tion in the professions. Moreover, she believed not only that male physicians should accept women as colleagues, but that they were obligated to allow female patients the option of selecting a woman doctor. Her lectures frequently stressed the role her students could play in teaching women the basics of preventive medicine, thereby improving family health. Addressing the graduating class of 1858, she said:

The women of this country are especially the sad victims of wrong hygienic conditions, and they need medical advisors with whom they can commune freely, who can not only prescribe medicines with skill, but who can explain to them the nature or the functions of their bodies, and the means for the proper regulation of daily habits and influences.

Although constantly aware of the public-service aspect of medicine, Dr. Preston also valued the personal satisfac­tions accompanying financial independence. Elsewhere in her address to the 1858 graduates, she stated:

While the practice of medicine should be truly a divine charity, of which the blessings of the poor are among the richest rewards, yet we trust it may also prove to you a means of pecuniary independence, available although connexions and trustees may fail, and stocks depreciate. Every woman who has had any experience in these practical matters, knows the keen sense of satisfaction with which she expends the pro­ceeds of her own exertions, and many a sad one can attest that pecuniary dependence is not less bitter to her than to her brother.

By 1858 many male physicians, as well as the general public, were beginning to acknowledge the abilities of women practitioners. Yet professional organizations were still denying membership to women, limiting their oppor­tunities to meet other physicians with similar interests and inhibiting their exposure to new ideas. The attempt to alter this situation, and to secure recognition of women M.D .s as fully qualified professionals, was a task that engaged Ann Preston for the remaining years of her life.

In November 1858, the Board of Censors of the Phila­delphia Medical Society recommended that members of the society should refuse consultation or any other profes­sional association with either graduates or faculty of female medical colleges, partly on the grounds that the Female Medical College of Pennsylvania was “irregular” in its ap­proach to medicine, but more basically because medicine was, for various reasons, considered an unsuitable profes­sion for women. The faculty of the Female College replied to the charge of “irregularity” by contending that their standards of instruction and practice were as high as those in any of the male colleges. Nevertheless, the State Medical Society sustained the adverse ruling. In 1867, the adminis­trators of the Female Medical College again appealed the ruling. The members of the Philadelphia County Medical Society discussed the matter at two meetings, but the only result was passage of the following resolution:

Resolved, That, in conformity with what they believe to be due to the profession, the community in general and the female portion of it in particular, the mem­bers of this Society cannot offer any encouragement to women becoming practitioners of medicine, nor, on these grounds, can they consent to meet in con­sultation such practitioners.

Dean Preston’s response to this resolution was published a month later in the Philadelphia Medical and Surgical Re­porter, the journal which reported activities of the county society. Point by point she demolished the spurious arguments raised against approving the practice of medicine by women, ending with the following appeal:

We must protest, in the sacred name of our common humanity, against the injustice which places diffi­culties in our way, not because we are ignorant, or pretentious, or incompetent, or unmindful of the code of medical or Christian ethics, but because we are women.

The Montgomery County Medical Society, and espe­cially one member, Dr. Hiram Corsan, supported the women in their struggle for professional recognition. Yet their appeals to the Philadelphia County Society were ignored, and thus women. who practiced medicine within the city were unable to attend either local or national medical meetings. At the national conventions of the American Medical Association in 1870 and 1871, even the male delegates from the Woman’s Medical College and Woman’s Hospital were refused seats. Nevertheless, Ann Preston had confidence that women would soon be ad­mitted to full membership in the professional societies, and she continued to work toward that goal. Unfortunately, she did not live to see the full fruits of her efforts, for al­though the State Medical Society rescinded the discrimina­tory resolution in 1871, it was 1888 before a woman was accepted for membership in the Philadelphia County Medical Society. That first woman member was Mary Willets, an 1881 graduate of the Woman’s Medical College.

Dr. Preston died April 18, 1872 from the effects of a recurrent rheumatic disease. During her life, she had the personal satisfaction of overcoming the difficulties in ob­taining a medical education for herself; but more impor­tantly, she ensured the continuing availability of such edu­cation to other women through her work for the Woman’s Medical College of Pennsylvania. By the time of Dean Preston’s death, 138 women had received the M.D. degree from the college, and both the college and its associated hospital were internationally recognized for their high standards of teaching and patient care . That a slightly built, frail-looking woman could have played such an im­portant role in bringing this about and in securing profes­sional parity for women physicians seems hardly credible until one remembers Ann Preston’s life before 1850. For it was during those early years on her father’s farm that she acquired the faith and self-confidence to overcome all obstacles in her later struggle for the rights of women and against the prejudices of the nineteenth-century medical establishment.

Joyce Fullard, born in Liverpool, England, was trained as a nurse in London and has worked as a Registered Nurse in both England and the United States. She also holds a Ph.D. in comparative literature and has taught literature and humanities at a number of universities. Presently, she is completing post-doctoral work in the administration of higher education at the University of Minnesota.