Quota of Four

In 1926, two young women named Elizabeth Sirmay and Verna Christophel wrote short letters to the registrar of Northwestern’s medical school.

Women had been knocking at the medical school’s door for more than half a century until things changed. Northwestern’s medical school was about to move into its impressive new building on the Chicago campus, and after nearly 60 years of being banned from the medical school, female students were ready to step through the school’s wrought-iron gates and into its labs.

The women did apply to Northwestern’s medical school. During Sirmay’s personal interview, the dean at the time, Dr. Irving Cutter, told her he was looking for “normal, average women in this school.” Years later, Sirmay wrote that the concept of normal, average women didn’t exist in medicine at the time. A normal, average woman wouldn’t have been able to succeed.

Sirmay’s boldness in her pursuit of education was matched by her exceeding compassion as a doctor – she took on patients who couldn’t afford her services, and when they needed hospital care but couldn’t foot the bills, she brought them to her home to offer care at all hours.

The first women to graduate from Northwestern’s medical school were anything but average. They were audacious – pioneers at a school that had long viewed women in medicine not only as inferior, but inadmissible.

The Failed Experiment

The earliest ancestor of today’s Feinberg School of Medicine, the Medical Department of Lind University was founded in 1859. Secondary education grew in the later part of the 20th century and with it, so did women’s medical schools. While access to a medical education expanded for women in segregated schools, a few women fought for their place in all-male schools.

Women were first admitted in 1869, a decade after the school opened its doors. That September, the faculty of Northwestern’s medical school brought the issue to a vote, and “resolved that females be admitted to the College and graduation on precisely the same terms as males.” That fall, the University admitted its first three female students: Mary H. Thompson, Odelia Blinn and Julia Cole.

They weren’t welcome for long. After just a year, too many male students had complained and “mixed classes” were deemed a disruption. The women weren’t allowed to return to their studies. The experiment was frought with discrimination that would last another 94 years.

"Upon The Same Terms"

The policy reversal on the admission of women came at a time when prospective female students were applying to medical schools in greater numbers, leading to the founding of the Woman’s Hospital Medical College in Chicago. The school became affiliated with Northwestern in 1892, but was closed 10 years later when Northwestern decided it was not profitable. In the early 1900s, more medical schools began to co-educate. Northwestern was considered progressive in terms of curriculum, but when it came to co-education, it lagged behind many of its peer institutions.

“Somewhat less liberal has been the long-time attitude toward women medical students, even though this country had pioneered in offering a medical education to women since 1849,” writes Dr. Leslie Arey, a Northwestern medical school professor who wrote a book chronicling its history.

There were plenty of chances for Northwestern to make the leap. In 1877, the school launched an exploratory inquiry into admitting women, but decided against voting on it. In 1913, the idea was brought up again at a council session, but “without any definite agreement or even consensus of opinion, the meeting adjourned.” It was on the administration’s radar, but there wasn’t much of a rush to act – that is, until money became involved.

In December 1923, Elizabeth Montgomery Ward donated $3 million for the first building on the Chicago campus, a new medical center, in honor of her late husband, Chicago retail giant A. Montgomery Ward. In doing so, she brought the conversation surrounding co-education to center stage. She remarked her surprise to the president when she learned that women weren’t allowed in the medical school.

“A committee, appointed to consider the matter and not reporting at three subsequent meetings, suddenly came to life and recommended favorably,” Dr. Arey writes. Co-education finally came to a vote by the Medical Council. Thirteen voted for it and five against it.

“This was largely considered an act of policy, rather than heart, since it was considered good business sense not to seem unchivalrous under the circumstances [of Ward’s gift],” Dr. Arey writes.

It was announced later that year that the Board of Trustees had approved the decision. The next item on the minutes of that board meeting was to accept the resignation of Dean Kendall, the head of the medical school.

“The question as finally stated for a vote was this – that women be admitted to the Medical School, after the new building is completed, upon the same terms as men,” the meeting’s minutes read.

Women would be allowed in, but with conditions. Though the vote was to admit women on the same terms as men, that wasn’t the case at all. The medical school set a quota of only four women per class each year. The precedent arose from the existing quotas in place for black and Jewish students.

Advisers thought it would be unseemly to mix men and women on dissection teams, which were made of four people each. The thought of men and women working on naked bodies together was repulsive, and the solution, they thought, would be to separate the women into their own work group. The four women started classes in the fall of 1926 with nearly 100 other male first-years.

Sirmay was one of the first four women admitted to the newly co-educated medical school. She was joined by Verna Christophel, Edna Ward and Frances Wynekoop. Wynekoop left the school prematurely, and in her place, Vera Slagerman enrolled as a third-year student.

“You have to be pretty bright and motivated to get through medical school today. Can you imagine what it was like to be a woman in medical school in those days?” says Julie Riggs, Christophel’s daughter, of her mother’s ambition.

The female students were frequently subjected to pranks from the male students, like the time they swapped out one female student’s hot dog in the cafeteria for a penis chopped off a cadaver.

But they passed gross anatomy and physiology, worked on doctors service, completed internships, and in 1931, became the first women to graduate from Northwestern’s medical school.

They were an accomplished bunch: Christophel went into practice with her father (who received a medical degree from Northwestern 20 years before his daughter), in her hometown of Mishawaka, Indiana. Ward worked for three state hospitals in Illinois and opened two private practices of her own. Slagerman headed to California after graduation and opened a private practice at the Los Angeles County General Hospital.

Pioneers in Practice

The women graduated near the beginning of the Great Depression, when going into practice was a huge financial hurdle: It was a tough time to scrape together the money to open an office, and even harder to find patients who were able to pay. Christophel, who went by Dr. Verna and refused to wear a lab coat while seeing patients (she preferred a nice suit and good jewelry), built up her practice by treating the large immigrant community. They were used to seeing midwives and were more open to the idea of a female doctor than other small-town residents.

Sirmay couldn’t afford to open her own office when she graduated, as was the standard practice, but a fellow doctor let her use his office to see patients during the times he wasn’t. For a long time, Sirmay couldn’t catch a break – she took all kinds of exams to find a salaried position as a doctor. She always scored well (receiving the highest score of all candidates on one of her qualifying exams) but the jobs were given to men.

Beyond the business side, Sirmay struggled with finding a balance between her career and personal life. Sirmay’s first choice of practice was surgery – it was her favorite part of her internship year. But becoming a surgeon would have required an extra three to five years of schooling.

“At this point, I had a most difficult decision to make. I wanted to marry and have a family,” Sirmay wrote. “I did not have the physical stamina to do a good job of both surgery and raising a family.”

Shortly after she graduated, Sirmay married and had her first and only child, a daughter. She went into general practice, which offered more stable working hours and fewer emergency calls than a surgeon might have.

Christophel was in the same boat. To make it work, she hired a live-in housekeeper to help take care of her kids. But still, like Sirmay, she couldn’t extend her practice the way other doctors could. She came home every night by 5 p.m. sharp – a time her children knew to be home by – and had dinner with her family.

“It didn’t occur to me that there was anything special about my mom being a doctor, but at that time not many moms were,” says Jack Riggs, Christophel’s son.

She sacrificed a social life, trading in bridge games with the girls to tend to a packed appointment book, a working husband and three children. She was as dedicated to her patients as she was to her children – when a certain elderly patient had to come in for a check-up, Christophel always saw her midday and used her lunch break to give the patient a ride home. Christophel always said she would die with her boots on, because she certainly wasn’t going to retire. She loved the work too much.

Sirmay eventually joined a clinic as an allergy specialist. She was the only female doctor, practicing alongside approximately 40 men. She challenged convention, becoming a senior partner in the clinic, but even with a seemingly powerful position, she had to hold herself back.

“I stayed out of the business affairs and politics of the clinic so there was no conflict with the men,” she says. The clinic wasn’t friendly to Sirmay – her partners never referred her patients like they did for each other and she had to padlock her supplies because the male doctors were “helping themselves.” While the early graduates of Northwestern’s medical school battled for a place in the medical community, prospective female students were still struggling for a real place in the classroom.

Holding Medical Schools Accountable

For 37 years after the decision, the University continued to admit just a handful of women each year. The quota perpetuated the long-held belief that female students simply weren’t as valuable or deserving of a medical education as male students.

But that was far from true – a 1964 questionnaire sent to female alumnae noted that 67 percent of women had practiced continuously in some capacity since graduating from Northwestern, and 77 percent of them worked full-time. A whopping 55 percent of female graduates were on specialty boards for medical associations. This was twice as many as the national average of female doctors and 1.4 times as many as the national average of men.

The quota quietly ended in 1963, with nine women admitted to the entering class that year. By 1978, the entering class contained 60 women. People began to hold medical schools like Northwestern’s accountable for their policies.

The Women’s Equity Action League sued every medical school in the U.S. in 1970, charging admissions abuses against female applicants. Five years after it was filed, the number of female medical students was three times higher. Mary Roth Walsh, who documented the movement in Doctors Wanted: No Women Need Apply, said the lawsuit aimed to hit medical schools where it hurt to get something done.

“Pressure had been brought to bear where it could yield the quickest results: blatant sex discrimination in recruitment and admissions procedures,” she writes. Title IX passed shortly after in 1972, a hefty push toward equality for women in all areas of education. The number of women in Northwestern’s medical school has grown since the quota broke, part of a larger national trend of more women entering the medical field. Women now make up the majority at Northwestern’s medical school, with 85 women and 78 men entering the most recent class.

Julie Riggs remembers how her mom felt when things started to change after being stagnant for nearly a century.

“She was really just disgusted about how little had changed between the time she became a doctor and the 1970s. I think she’d be amazed about what has happened today. She’d say, ‘It was one thing to earn the respect of my peers, which I did. But every time a new batch of residents came into town, I’d have to break them in. They all came to town thinking because they were men, they were better doctors than me. And I’d have to set them straight.’”