It’s a pleasure to be here. It’s a pleasure to see old friends. I’m looking forward to meeting new friends at this workshop.

I am here today in the role of a historian, not a strategist. Strategists will talk tomorrow. If you have read How the Irish Saved Civilization, you will understand the subtitle of my speech, “How Women Saved American Medicine.” As a historian, I will make three points before putting on the hat of a clinician. First, women established high academic standards for medicine. Second, women maintained those standards when men began to default. Third, women led the fight to enhance the quality of life for physicians. When, and not if, we succeed, men will have gender equity for the first time, as well as women.

To my first point, Johns Hopkins University School of Medicine set the standard for American medicine when it admitted its first class in 1893. What you may not know is that the medical school almost did not open. The trustees called a halt when the Hopkins endowment shrunk below the necessary minimum after the stock market crashed. Five Baltimore Quaker women—Carey Thomas, Mary Elizabeth Garrett, Elizabeth King, Julia Rogers, and Mary Gwinn—stepped into the breach. They offered the necessary funds on two conditions. First, women had to be accepted on the same terms as men. Second, a baccalaureate degree and a real knowledge of French and German would be required for admission. Accepting token women was less objectionable than setting high educational standards. Trustees and faculty alike feared pricing themselves out of the applicant market. As Sir William Osler said to Dr. William Henry Welch, “It is likely we’re getting as professors those who would never enter as students.”

But the women were adamant, and Hopkins took the plunge. Carey, Mary, Elizabeth, Julia, and Mary had elevated the intellectual standards of American medicine for the century and the millennium to come. Harvard followed Hopkins’ lead eight years later—that is, in requiring a bachelor’s degree; it took another 50 years to admit women. Abraham Flexner put it succinctly in 1910: “John Hopkins graduates in medicine represent the highest quality this country has produced.”

As for the second point, nearly a century later women came to the rescue of American medicine again. In the mid-1970s, the number of male applicants to medical schools began to decline. Ten years later, there were fewer qualified male applicants than places in the first-year class. By the late 1980s, there were not enough male applicants, qualified or not, to fill a freshman class. How were academic standards maintained in the face of the massive male default? The answer is straightforward: women constituted a third of the admitted class.

What had enabled women applicants to increase five-fold between the 1960s and the 1980s? Had there been a mutation in the M.D. gene or the X chromosome? I have found no support for that hypothesis. Could there have been a

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